Dr. J. Douglas Bremner, MD


Mechanisms of Stress, Depression and PTSD in Cardiovascular Disease and Response to Interventions

Posttraumatic stress disorder (PTSD) and depression are associated with increased risk of coronary artery disease (CAD), but the mechanisms of this are not well known, although stress likely plays an important role. We performed cardiac imaging with positron emission tomography (PET) and quantitatively demonstrated increased CAD in patients with PTSD and depression using twins discordant for these disorders. We have also modeled a laboratory-based model of stress that can induce myocardial ischemia in patients with CAD. Mental Stress Ischemia (MSI) is associated with poor prognosis and risk of sudden death. Mechanisms of MSI are not well known, but we have performed simultaneous brain and cardiac imaging studies and shown increased activation with MSI in the rostral anterior cingulate. Interventions studied for MSI patients include biofeedback. We have also assessed effects of vagal nerve stimulation and Mindfulness Based Stress Reduction (MBSR) on brain, inflammatory and cardiovascular responses in PTSD. This research may have implications for treatment interventions for patients with CAD who are vulnerable to stress.

About Dr. Bremner

Professor of Psychiatry and Radiology, Emory University School of Medicine, Atlanta GA. Dr. Bremner's research used neuroimaging and neurobiology measures to study the neural correlates and neurobiology of posttraumatic stress disorder (PTSD) related to combat and childhood abuse, as well as the related area of depression, and the relationship between brain, behavior, and physical health including studies of neurobiological mechanisms mediating the effects of stress and depression on cardiovascular disease, as well as the effects of different treatments on the brain. His studies using magnetic resonance imaging (MRI) to show smaller hippocampal volume in PTSD are amongst the most highly cited in the field. He has authored over 400 scientific articles and book chapters, edited three books, wrote six books including You Can't Just Snap Out of It and Guiding Clients in Recovery from Psychological Trauma, and developed and validated the Early Trauma Inventory (ETI) and the Clinician Administered States Scale (CADSS).

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