Biomarkers May Aid PTSD Diagnosis, Treatment

Many psychiatrists use clinical questionnaires and self-reports to diagnose mental disorders in patients. Charles Marmar, M.D., chair of psychiatry at New York University Langone Medical Center and an expert in posttraumatic stress disorder (PTSD), says the current dependency on “paper-based” assessment tools must change as the field of psychiatry progresses in the coming years.

One alternative approach to diagnosis and assessment, he suggested at the APA Institute on Psychiatric Services this fall, is the use of biomarkers.

“Biomarkers are important in medicine,” Marmar told Psychiatric News. “They have altered the fields of cancer and heart disease, and could very likely do the same for psychiatry.”

Marmar, who spoke on the benefits of biomarkers in the diagnosis and treatment of PTSD, described several reasons why biomarkers are a significant advance and discussed his research findings on why biomarkers should be considered a useful tool in psychiatry, especially for PTSD among military veterans.

“Many who serve are reluctant to disclose symptoms [of PTSD] because of stigma or the fear that reporting their condition might keep them from advancing in their military careers,” Marmar explained. Conversely, “some people—though a small minority—will dramatize symptoms if compensation is involved and to avoid [further] service in the military. Relying on questionnaires, brief screening measures, and self-reporting can be problematic.”

Marmar told Psychiatric News that research with biomarkers has shown promising findings, including a functional brain imaging study that showed that patients with PTSD display more activity in areas of the brain that regulate fear when they sleep and less activation in areas that regulate emotion when they are trying to relax—the opposite of what has been seen in patients without PTSD.

Genetic biomarkers and biomarkers that regulate metabolism have also yielded promising results. In a study of 100 men with and without PTSD, Marmar and colleagues found that high levels of brain-derived neurotrophic factor (BDNF) protein were correlated with an increased risk for PTSD. In addition, he presented data from his ongoing study with cortisol showing that elevated levels of urinary cortisol appears to be a biomarker in both men and women with PTSD.

Marmar said in a later interview with Psychiatric News that he and his colleagues have received $20 million from the Steven and Alexandra Cohen Foundation to conduct a study comparing biomarker profiles in patients with PTSD with those of individuals with depression and individuals with traumatic brain injury to help identify characteristics that are unique to biomarker profiles for PTSD.

Marmar concluded, “I would like for psychiatrists to be aware that the field of psychiatry is rapidly advancing to a field in which we can use technology for the treatment and diagnosis of mental health disorders. We have very sophisticated tools for detecting biomarkers in the brain, blood, and other systems to help treat and confirm—as well as disconfirm—psychiatric diagnoses, and this will allow us to provide the best care for those who are in most need of mental health services.” ■