Post Traumatic Stress Disorder and Substance Use Disorder as Two Pathologies Affecting Memory Reactivation: Implications for New Therapeutic Approaches

Abstract

In the present review, we provide evidence indicating that although post traumatic stress disorder (PTSD) and substance use disorder (SUD) are two distinct pathologies with very different impacts on people affected by these chronic illnesses, they share numerous common characteristics, present high rates of co-morbidity, and may result from common physiological dysfunctions. We propose that these pathologies result from hyper reactivity to reminders, and thus should be considered as two disorders of memory, treated as such. We review the different possibilities to intervene on pathological memories such as extinction therapy and reconsolidation blockade. We also introduce new therapeutic avenues directly indicate by our recent proposal to replace the consolidation/reconsolidation hypothesis by the integration concept. State dependency and emotional remodeling are two innovative treatments that have already provided encouraging results. In summary, this review shows that the discovery of reactivation-dependent memory malleability has open new therapeutic avenues based on the reprocessing of pathological memories, which constitute promising approaches to treat PTSD and SUD.

Emotional remodeling with oxytocin durably rescues trauma-induced behavioral and neuro-morphological changes in rats: a promising treatment for PTSD

“…In conclusion, oxytocin-based emotional remodeling, a treatment where oxytocin is delivered in association with memory reactivation, is effective in reversing the manifestation of behavioral and neural PTSD symptoms even long after its administration. It therefore appears as a promising therapy for durably tackling abnormally persisting memories with a high motivational/emotional content 5,7 .…”

“…Among the mechanisms which have been proposed to explain the oxytocin therapeutic effects (see ref. 5 ), a first possibility is that oxytocin blocks the process of memory reconsolidation, considered to be required to re-stabilize a reactivated memory 60 . However, this hypothesis is unlikely for two main reasons.…”

“…This new memory with a lower emotional component could therefore reduce the forthcoming impact of the trauma. Of note, PTSD therapies based on the induction of a positive state during memory reactivation (e.g., EMDR: movement desensitization, CBC: cognitive behavioral therapy) also exploit the malleability of reactivated memories 5 . Thus, EMDR or CBC protocols combined with oxytocin treatment should considerably enhance their therapeutic efficacy.…”

“…Intrusions of traumatic memories and flashbacks, that occur either spontaneously or in response to trauma cues, are core symptoms of the post-traumatic stress disorder (PTSD). Hence, a variety of therapeutic protocols aimed at decreasing the emotional valence of traumatic cues (e.g., extinction or exposure therapies) have been proposed 1 but their efficacy is questioned by regular observation of a high rate of relapse [2][3][4][5] .…”

microRNA mir-598-3p mediates susceptibility to stress-enhancement of remote fear memory

“…Persistent, maladaptive long-term memories are an integral part of several psychiatric disorders, including substance use disorder (SUD, [1]) and post-traumatic stress disorder (PTSD, [2]). While much of the current literature has focused on mechanisms supporting recent memory acquisition and consolidation [3], a greater understanding of the neurobiological mechanisms governing persistent, enhanced remote memory could provide new insight into treatment of memory-related disorders.…”