Atomoxetine Effect on Attention, Executive Function, and Quality of Life in Veterans with Posttraumatic Stress Disorder
openNIH
Attention deficits (AD) frequently co-occur with posttraumatic stress disorder (PTSD). The presence of AD is
associated with greater PTSD clinical severity and poorer clinical outcomes. Knowledge regarding the
mechanism underlying this association is limited, though the emerging evidence has indicated that executive
function deficit (EFD) is strongly correlated with AD and PTSD symptoms. While treatments developed for
PTSD have existed for years, a substantial portion of individuals do not fully respond to conventional treatment.
Accumulating evidence suggest that attention deficit (AD) and EFD may be a driving force for PTSD treatment
resistance. However, treatment of executive impairment in PTSD is very limited. As a result, untreated co-
occurring AD and EFD in PTSD poses severe negative impacts on patients’ functional recovery, treatment
outcomes, and quality of life (QoL). Given that up to 50% of patients do not respond well to the first-line
pharmacological PTSD treatments, it is imperative to seek novel treatment strategies to improve EF that may
improve both standard treatment response and QoL, social function. The proposed study directly addresses
this knowledge gap by testing the efficacy of atomoxetine (ATX) in improving EF and attention among Veterans
with PTSD, which will further improve Veterans’ QoL and social function. ATX represents a promising novel
candidate pharmacotherapy for individuals with PTSD. ATX is a non-stimulant selective norepinephrine
reuptake inhibitor (SNRI), approved by the FDA for the treatment of ADHD. Studies suggest that ATX, unlike
stimulants, lacks addictive properties and shows efficacy in the treatment of comorbid depression and anxiety,
which is ideal in the treatment of PTSD. Data from our preliminary study provides encouraging support for the
therapeutic potential of ATX in improving EF in Veterans with comorbid PTSD/ADHD. Our recent research
uncovered a higher rate of ADHD among veterans with PTSD, and the comorbid AD symptoms were
correlated with PTSD severity and poorer treatment outcomes. Treatment with ATX showed significant
symptoms reduction in ADHD and improvement in inhibitory function in Veterans with ADHD/PTSD. In the
proposed study, we will focus on ATX in improvement of EF and attention, and further psycho-social life
function and QoL. We will (1) employ a randomized, double-blind design that will consist of 12 weeks of
treatment with ATX or placebo medication; (2) use standardized, repeated dependent measures to rigorously
assess AD and EFD symptomatology; (3) measure impairment in associated mental and behavioral health
problems (e.g., attention deficit, depression, anxiety, suicidality, QoL, family/social functioning); and (4) use
response inhibition task GoNogo, working memory and attention tests Digit Span and Trail Making to
investigate the underlying pathophysiology of PTSD and prognostic indicators of treatment outcome. To
achieve these goals, we have assembled a multidisciplinary team of investigators with expertise in PTSD,
ADHD clinical trials, and human laboratory paradigms who have successfully collaborated in the past and are
uniquely qualified to implement this type of investigation. The proposed project is directly responsive to the
mission of the VA-RRD “to maximize Veterans’ functional independence, quality of life and participation in their
lives and community.” Successful completion of this study will provide a platform for a large multi-center trial to
further confirm the important role of EF in PTSD treatment outcomes. The findings from this study will provide
critically needed evidence to help inform clinical practice guidelines on the treatment of PTSD. The outcome of
the proposed research will be significant, because it provides a knowledge base to allow for development of
new PTSD intervention strategies. More importantly, this clinical trial may immediately benefit Veterans by
enhancing their cognitive function, reducing AD related disability, and further improving quality of life for
veterans who suffer from PTSD.