**5.3 Omega-3 fatty acids and hippocampal neurogenesis**

Fear consolidation can be blocked by an antagonist of noradrenergic activation, and the effectiveness of beta blockers for secondary prevention of posttraumatic stress disorder has been studied in clinical trials (Pitman et al., 2002; Vaiva et al., 2003). However, as traumatized individuals are not psychiatric patients, daily life-based intervention for the prevention of posttraumatic stress disorder is preferable.

Based on the animal research conducted to date, omega-3 fatty acids are the most promising candidate for dietary intervention in the aftermath of a traumatic event to facilitate adult hippocampal neurogenesis (Beltz, 2007; Calderon & Kim, 2004; Kawakita et al., 2006; Wu et al., 2004, 2008). The possible effects of omega-3 fatty acids on brain structures have also been observed clinically: a significant correlation was found between omega-3 fatty acid consumption and gray matter volume of the amygdala, hippocampus, and anterior cingulated gyrus in healthy adults (Conklin et al., 2007). Conversely, a selective deficit of docosahexaenoic acid was reported in the postmortem frontal cortex of patients with depressive disorder (McNamara et al., 2007). Following discussion of these results in the literature, Matsuoka proposed that promoting hippocampal neurogenesis by omega-3 fatty acid supplementation after trauma could reduce subsequent posttraumatic stress disorder symptoms (Matsuoka, 2011).

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Support for the ability of omega-3 fatty acids to minimize subsequent posttraumatic stress disorder symptoms comes from one published but preliminary open trial (Matsuoka, Nishi, Yonemoto, Hamazaki et al., 2010). The author and colleagues recruited 15 consecutive patients admitted to the intensive care unit oft a Japanese general hospital immediately following accidental injury (mostly motor vehicle accidents). Patients received omega-3 fatty acid capsules containing 1,470 mg docosahexaenoic acid and 147 mg eicosapentaenoic acid daily for 12 weeks. The primary efficacy variable was score on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS). Omega-3 fatty acid supplementation was well tolerated and resulted in a significantly increased docosahexaenoic acid concentration in erythrocytes. Compared with the hypothetical mean calculated in our previous cohort study (Matsuoka et al., 2009), omega-3 fatty acid supplementation resulted in a significantly reduced mean total score on the Clinician-Administered PTSD Scale (11 vs. 25, p = 0.03). This pilot study provided promising support for our hypothesis that omega-3 fatty acid supplementation started shortly after accidental injury may be efficacious in attenuating the symptoms of posttraumatic stress disorder. However, because of the open-label design and the lack of controls, no definitive conclusion could be drawn from the trial and we must wait for the results of an adequately powered randomized controlled trial (ClinicalTrials.gov Identifier: NCT00671099).

#### **6. Conclusion**

Peritraumatic distress can be assessed quickly and efficiently by using the Peritraumatic Distress Inventory and is an indicator for posttraumatic stress, depressive and anxiety symptoms, and posttraumatic growth in motor vehicle accident survivors. The Peritraumatic Distress Inventory can be used in the emergency department for early identification of motor vehicle accident survivors who are unlikely to develop posttraumatic stress disorder, and the combination of screening with the Peritraumatic Distress Inventory and supplementation with omega-3 fatty acids might be an effective preventive strategy for posttraumatic stress disorder in motor vehicle accident survivors.

#### **7. References**


Support for the ability of omega-3 fatty acids to minimize subsequent posttraumatic stress disorder symptoms comes from one published but preliminary open trial (Matsuoka, Nishi, Yonemoto, Hamazaki et al., 2010). The author and colleagues recruited 15 consecutive patients admitted to the intensive care unit oft a Japanese general hospital immediately following accidental injury (mostly motor vehicle accidents). Patients received omega-3 fatty acid capsules containing 1,470 mg docosahexaenoic acid and 147 mg eicosapentaenoic acid daily for 12 weeks. The primary efficacy variable was score on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS). Omega-3 fatty acid supplementation was well tolerated and resulted in a significantly increased docosahexaenoic acid concentration in erythrocytes. Compared with the hypothetical mean calculated in our previous cohort study (Matsuoka et al., 2009), omega-3 fatty acid supplementation resulted in a significantly reduced mean total score on the Clinician-Administered PTSD Scale (11 vs. 25, p = 0.03). This pilot study provided promising support for our hypothesis that omega-3 fatty acid supplementation started shortly after accidental injury may be efficacious in attenuating the symptoms of posttraumatic stress disorder. However, because of the open-label design and the lack of controls, no definitive conclusion could be drawn from the trial and we must wait for the results of an adequately powered randomized controlled trial

Peritraumatic distress can be assessed quickly and efficiently by using the Peritraumatic Distress Inventory and is an indicator for posttraumatic stress, depressive and anxiety symptoms, and posttraumatic growth in motor vehicle accident survivors. The Peritraumatic Distress Inventory can be used in the emergency department for early identification of motor vehicle accident survivors who are unlikely to develop posttraumatic stress disorder, and the combination of screening with the Peritraumatic Distress Inventory and supplementation with omega-3 fatty acids might be an effective preventive strategy for

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Research into the psychological sequalae of trauma originally started out by focusing on two sex-specific trauma populations: male war veterans with "soldier's heart", "shellshock", "battle fatigue", or "war neurosis" and female victims of sexual assault or domestic violence with "rape trauma syndrome" or "battered woman syndrome". It was noted how the flashbacks and nightmares reported by rape survivors were similar to the symptoms reported by war veterans, and several researchers and clinicians started pointing out that these trauma specific syndromes might be more similar than different (Ray, 2008; Van der Kolk, 2007). Finally, it was the large number of male Vietnam veterans and the activities of feminist and student organisations, which led to the inclusion of the first PTSD diagnosis into the American DSM-III in 1980 (American Psychiatric Association, 1980). With the introduction of the PTSD diagnosis, the idea that the male war neurosis and the female rape trauma syndrome were ultimately manifestations of the same disorder was widely accepted. As a result, most research on PTSD has been based on the idea that males and females are traumatised in similar ways, and studies on sex differences in PTSD have primarily focused on examining and explaining sex differences in the prevalence and severity of PTSD, whereas studies on sex differences in the manifestation of PTSD are almost completely

Most literature on sex differences in PTSD uses the terms sex and gender interchangeably. Traditionally, however, the term sex refers to the biological distinction between males and females, whereas gender refers to the much more complex cultural understanding of masculine and feminine gender roles as they are viewed in the context of not only sex, but also culture, subculture, age, race, class, and sexual orientation. Even though many studies on PTSD claim to examine gender differences, most studies have in fact studied sex differences and only few have looked into the effect of masculinity or femininity on PTSD. Although this chapter will focus primarily on sex, we acknowledge that gender is likely to affect the development and maintenance of PTSD in males and females as well. The contribution of sex versus gender based explanations for sex differences in PTSD will be discussed throughout the chapter, although the topic merits a more thorough discussion

absent from this otherwise expanding area of research.

**1. Introduction** 

than is possible here.

Dorte Christiansen1 and Ask Elklit2 *1Aarhus University, Institute of Psychology, 2National Center for Psychotraumatology,* 

*University of Southern Denmark,* 

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