Spotlight on VA Research

Spotlight on VA Research Advances Mood Disorders

VA Research is making important headway in the treatment, screening, and diagnosis of mood disorders such as depression, bipolar disorder, persistent despondency, and seasonal affective disorder.

Important areas of VA research on mood disorders include:

• Determining the benefits of cognitive behavioral therapy, a type of psychological therapy that examines patterns of thought and belief.
• Developing models of family interventions and social support to promote recovery from mood disorders.
• Understanding whether certain risk factors make a person more likely to suffer from depression or respond to a specific medication.
• Identifying and testing potential new drugs for depression.

Anxiety Disorders

Anxiety is a normal biological reaction to a stressful event, but in some cases, anxiety continues for a long period and may worsen over time, with symptoms such as nightmares, racing pulse, and overreactions. In persistent cases, anxiety disorders such as posttraumatic stress disorder (PTSD), panic disorders, or phobias may develop. VA research toward improving treatment for patients with anxiety disorders includes:

• Using brain imaging to study differences between patients with and without anxiety disorders.
• Studying anti-anxiety (as well as anti-depressive) drugs to determine how they work in the brain, and how hormones and other chemicals may influence drugs' effectiveness.
• Further exploring the VA-discovered genetic and biochemical pathways that show a link between anxiety and alcohololism and may point the way to new drug targets for both conditions.

Posttraumatic Stress Disorder

In recent years, VA investigators have made vital strides in understanding how the brain works in PTSD, an anxiety disorder often associated with Veterans exposed to combat but that also occurs in the general population. VA researchers have established much of the evidence relating to the biological basis of PTSD—a disorder that during past wars was called "soldier's heart," "shell shock," or "combat fatigue." VA researchers have looked at many different aspects of PTSD, including associated brain changes; factors that may increase a person's risk for developing the disorder; and strategies for prevention and treatment.

Some important ongoing studies are:

• Testing whether computer-simulated, "virtual reality" combat environments can enhance the effectiveness of prolonged exposure therapy.
• Exploring whether prazosin, a commonly prescribed high blood pressure medication, can lessen sleep disturbances and nightmares in patients with PTSD.
• Determining the most effective ways to deliver psychotherapy—in individual or group settings or with telephone or Internet reminders, for example.

VA researchers often focus on particularly challenging or less-studied aspects of mental health. Two recent examples are:

• While most patients recover from PTSD, some develop chronic cases that do not respond well to medication or therapy. The VA Cooperative Studies Program is conducting a large, multi-site clinical trial in this population to determine whether the drug risperidone helps to relieve chronic PTSD when added to standard medication.
• VA researchers' recent findings from the largest study to date involving women Veterans with PTSD indicate that a type of therapy called prolonged exposure therapy is effective for this group. The VA is systematically adopting this treatment approach. Journal of the American Medical Association. 2007;297(8):820-30.

Psychotic Disorders

Psychotic disorders such as schizophrenia affect a small proportion of the general and Veteran population but can have devastating effects. Each year, VA provides care to about 100,000 Veterans with schizophrenia.

Important areas of VA research into schizophrenia include:

• Using state-of-the-art imaging techniques to identify brain structures important in schizophrenia and studying how the structures respond to various medications.
• Determining how Veterans with schizophrenia can function at their highest level through improvements in vocational rehabilitation and social cognition training.

Dementia and Memory Disorders

Dementia is a general term for disorders involving a decline in memory, thinking, judgment, and learning ability. As the Veteran population ages, Alzheimer's disease and other forms of dementia are an increasingly pressing concern.

VA research related to dementia include:

• Investigating certain proteins in the blood that appear to predict the onset of Alzheimer's disease and could be the basis of a screening test.
• Studying the dietary supplements DHA (docosahexaenoic acid, a type of fat found in fish, fish oil, and certain nuts) and curcumin (a yellow pigment found in the spice turmeric) for their possible role in the prevention and treatment of Alzheimer's disease.
• Investigating the biological basis of memory to help identify abnormalities in patients with dementia or other memory disorders.

Substance Use Disorders

Substance use and abuse, with its associated health consequences, is a major public health problem and commonly occurs with other mental and physical problems such as depression or chronic pain. Health care costs associated with substance abuse amount to more than $484 billion per year-more than twice the national cost of caring for cancer.

Important areas of VA research into substance use and abuse include:

• Demonstrating that telephone counseling helps Veterans quit smoking.
• Studying interventions, such as antidepressant medication, to simultaneously treat depression and substance abuse.
• Showing that timely treatment by a health care professional and/or participation in Alcoholics Anonymous is associated with faster improvement and higher long-term remission in alcohol use disorders than "natural remission" (getting sober without formal treatment or help).