How Stress And Trauma Impact The Brain ▶ Trauma And The Brain - Neurobiology of PTSD 2020

Dr Sanil Rege takes you through the impact of trauma and stress on the brain.

This video presents how stress and trauma impacts the brain but also covers the following subjects:
-Trauma and the brain - neurobiology of PTSD
-Trauma and the nervous system

One thing I observed when I was looking for info on how stress and trauma impacts the brain was the lack of pertinent information.
Hope this is relevant and of interest to you.

The hypothalamic-pituitary-adrenal (HPA) axis in the brain is the central coordinator of how humans respond to stress and trauma. The stress response starts in the hypothalamus where paraventricular neurons (PVN) secrete corticotropin-releasing hormone (CRH).

This hormone stimulates the release of adrenocorticotropin hormone (ACTH) from the anterior pituitary, which in turn stimulates the release of glucocorticoids (e.g. cortisol) from the adrenal cortex.

Cortisol exerts negative feedback control of the HPA. Cortisol also reduces the noradrenergic stress response.
In Post-traumatic stress disorder (PTSD), there exists a dysregulation of glucocorticoid signalling underpinned by heightened negative feedback sensitivity of the HPA. This results in low cortisol levels and blunted ACTH responses to CRH due to elevated levels of CRH resulting in down-regulation of CRH receptors on the anterior pituitary.
Two genes that are thought to be involved are NR3C1 (encoding the glucocorticoid (GC) receptor) and FKBP5 (role in immunoregulation and regulating the amount of GC available to the GC receptor)

The dynamic interaction between the medial prefrontal cortex and the amygdala creates two distinct phenotypes in PTSD patients.
In many patients, a phase-oriented therapy is more appropriate focusing on reducing hyperarousal in the short term allowing them to engage in trauma-related psychotherapies after emotional dysregulation and hyperarousal are addressed.--------------
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Now that you have actually viewed my vid about how stress and trauma impact the brain did it help?
Please like the YouTube vid to assist your friends looking for trauma and the brain neurobiology of PTSD or trauma and the nervous system :)

[sovereignsoulutions]

This is THE BEST video on explaining PTSD and HPA dysregulation. 🙏🏼

[AgentKodak]

Great job with the video Doc! I really appreciate it. I’m trying to understand this condition more and more by the day and although it’s hard it’s good to know that somebody’s out there studying it and educating other veterans

[alicerose]

Thank you! Such a good, concise explanation of why this condition is so hard to get over.

[a.b.]

Excellent. Exactly the information I was looking for. Thank you.

[NearlyNomads]

Thank you, this is exactly what a nerd like me needed today.

I would love to see your explanation of the impact of norepinephrine being released into the system and what happens if it is at elevated levels over a long timeframe.

[alumi]

this is simplistic as many people with ptsd have elevated cortisol

[philholding]

At last, a good neurological explanation for PTSD. As a recently retired NHS high intensity EMDR/CBT therapist, this appears to converge with my research studies. Not so keen on the background music though, appears a bit incongruent. Would be nice to see a future clip on trauma related dissociation. This clip has passed my strict recording criteria.

[godwatching]

It will drive you crazy..seek help ASAP if you going through it

[simply.mimi]

This video is amazing, thank you so much!

[ananigalindo]

amazing video! so informative :) thank you!

[CarolynElizabethJones]

This is great information! Can you explain to me why there is typically reduced brain volume in patients with PTSD? I have tried to find this info; however, I cannot seem to get a clear explanation. I am doing some research for an assignment for grad school. Any info you have on this would be great...even if you can point me to an article that discusses this, I would really appreciate it!

[drkhan]

Thanks a lot sir for this great explanation. Keep up the good work and try to cover all common psychiatric disorders and their treatments.
Which book would you recommend sir for common psychiatric disorders and their treatment, that would be easily understood and retained.
Thanks

[janechu]

To reduce noradrenaline, is it common that guanfacine is also used? Theoretically, if a person is on an alpha 2 agonist and never resolves their trauma/anxiety through other therapeutic means, would the body/brain build a tolerance to the alpha 2 agonist? Wondering if it’s considered as a long term solution.

[horatiogrant]

Hello Dr Rege,

I have tried to find this but cannot. Sure hope you can resolve:

HDAC inhibition of Valproic acid to reverse epigenetic change from childhood trauma. Could you advise if those reversals hold or does one have to keep taking valproate indefinitely?

Thank you kind Sir

[bpggg]

Is there a similar process that happens in Bipolar Disorder (or Major Depression for that matter) ? I thought cortisol in excess amounts induces hippocampal atrophy. Does this also happen in PTSD (hippocampal atrophy) or in PTSD have an opposite effect (hippocampal neurogenesis)? I know people can have residual cognitive issues even after considered to be in remission in mood disorders. Can people with PTSD have traumatic memories that are strong and yet have general impairment in encoding new memories?

[Frisson]

Feedback loop cortisol does not shut off CRH RELEASE FROM THE HYPOTHALAMUS. CRH CONTINUES TO BE RELEASED FROM HYPOTHALAMUS BUT …Pituitary does not respond to CRH “the pituitary is sensitized”. Did you mean desensitized?

ALSO WHAT RECEPTOR CHANGES ARE HAPPENING at the pituitary that cause it to not respond to continued CRH release from the hypothalamus?

[jocs]

I had an overnight metyrapone (blocks the enzyme just before cortisol of adrenal hormones) test done to check if the hpa axis was intact as I have low but within range morning blood, saliva midnight and saliva and urine all day cortisol despite feeling stressed most of the time. The result of the test was that the pituitary definitely responds as the precursor to cortisol shot right up and stayed up well into the next morning. Does that rule out PTSD then? I also have very limited memories of my traumas from childhood and since then even as my memory is generally low overall. I have had trouble tolerating ssri antidepressants for depression(too much anxiety side effect) and dr wondered if it was ptsd so we had the adrenal tests to find out. Does it sound like this is not PTSD? My DHEA is within range but high end and it normally travels with cortisol. Acth is not high. There is some research on PTSD saying a faster deactivation of cortisol to cortisone occurs when childhood trauma epigenetically changes the enzymes for life aftet that. Is that the explanation I wonder and are the alpha 2 blockers still applicable then in my case despite not having a good memory but certainly feel on high alert from noradrenaline maybe? Can very high noradrenaline also cause low memory formation? Maybe bit like adhd where I cannot filter out irrelevant stimuli so cannot focus to form the memory?? They use guanfacine for that type of ADHD I think. My son has adhd but no traumas like me BTW. He does well on stimulants however. I tried them but couldn't sleep. Is Prazosin still going to help if I don't have nightmares or flashbacks as I don't recall the traumas in detail and generally don't think about them either. My issues are depression with anxiety/agitation/sleep difficulty. I worry constantly about everything and everyone. Sad about the world and cry easy. Is this just depression now from lowish cortisol/inflammation? I don't have any elevated inflammation markers on my blood tests like crp or esr. I take fish oil daily and eat gluten free as my gut hurts with gluten. Not celiac though.

[Killdozing]

Thank you for the excellent video. One quick point of clarification. Around minute 6, you introduce alpha-2 agonists including clonidine and prazosin. My understanding is that the latter agent is an alpha-1 agonist/inverse agonist. Is that true? Thanks!

[jamescullen-]

Hi Sanil,

Is there a link between pots and PTSD? Can PTSD potentially bring about symptoms that can be seen in postural orthostatic tachycardia syndrome?

[Marianne_]

If the negative feedback loop is sensitised then why is there CRH still being released from the hypothalamus? Also if it’s sensitised then why is there a cross going through it in your image, doesn’t sensitised just mean that less cortisol is needed to shut off the stress response in the hypothalamus?