Neural Correlates of Early Intervention for Posttraumatic Stress Disorder (PTSD)

Study Design: Subjects returning from Iraq who meet criteria for early PTSD (N=160) will be included in the study with a recruitment goal of 144 completers. A group of 80 healthy subjects with a history of military service during the period of OIF without a history of deployment and without PTSD and 80 healthy subjects with a history of deployment without PTSD will serve as comparator groups. All subjects will undergo baseline imaging of the brain with PET FDG and with measurement of brain blood flow during a memory task and with exposure to trauma related reminders (slides and sounds) and MRI and baseline psychometric assessments, following which PTSD subjects will be randomized to receive paroxetine or placebo for three months, with repeat imaging and assessments. After this PTSD subjects will be treated with three months of open label paroxetine, followed by a repeat of imaging and assessments. This will be an intent to treat analysis, therefore all subjects who were randomized and took at least one dose of study medication will be assessed at three months, regardless of whether they were able to stay on study medication. This will complement our currently VA Clinical Trial Merit funded application to measure hippocampal volume, NAA, and cortisol response to stress before and after early intervention with paroxetine in returning Iraq vets with early PTSD.