Hydrocortisone for Preventing PTSD

Recruiting in Palo Alto (17 mi)

+2 other locations

Overseen by Rachel Yehuda, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Waitlist Available

Sponsor: Rachel Yehuda

Must not be taking: Oral steroids, Benzodiazepines, Narcotics

Disqualifiers: Severe injury, Pregnancy, Schizophrenia, others

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial tests whether a single dose of hydrocortisone (HCORT) can prevent PTSD in highly distressed trauma survivors. HCORT works by boosting the body's natural stress recovery system. If successful, this could provide a simple, portable treatment for those at high risk of PTSD.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are currently taking oral steroids or have used benzodiazepines within 24 hours of trauma exposure.

What evidence supports the effectiveness of hydrocortisone in preventing PTSD?

Research shows that hydrocortisone, when given shortly after a traumatic event, can reduce the risk of developing PTSD. It also helps improve treatment outcomes and reduce dropout rates in therapy for PTSD by lessening the distress from traumatic memories. ^{1 2 3 4 5}

Is hydrocortisone safe for humans?

Hydrocortisone has been studied in various trials for its effects on post-traumatic stress disorder (PTSD) and has shown to be generally safe in humans. These studies involved different doses and methods of administration, and no significant safety concerns were reported. ^{1 2 3 4 5}

How does hydrocortisone differ from other drugs for preventing PTSD?

Hydrocortisone is unique in its use for preventing PTSD because it targets the body's stress response system (the hypothalamic-pituitary-adrenal axis) immediately after trauma, potentially reducing PTSD symptoms by stabilizing stress hormone levels. This approach is different from traditional psychological therapies and is still being explored as a novel pharmacological intervention. ^{2 3 4 5 6}

Research Team

Rachel Yehuda, PhD

Principal Investigator

Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center

Eligibility Criteria

This trial is for adults who've recently experienced trauma, feel highly distressed or disconnected, and have a heart rate of 80 bpm or more. They must weigh between 99-242 lbs and not be severely injured, intoxicated, pregnant, on steroids or benzodiazepines, nor have certain chronic diseases or mental health conditions.

Inclusion Criteria

You experienced significant emotional distress during or after a traumatic event, as measured by a questionnaire with a score of 15 or higher.

My weight is between 99 and 242 lbs.

I experienced a traumatic event within the last 6 hours.

Exclusion Criteria

I have not been prescribed narcotics for acute pain in the emergency department.

Intoxication to a degree that would interfere with the ability to provide informed consent or high level or intoxication reported at the time of trauma.

I live too far to attend follow-up visits without difficulty.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive a single dose of hydrocortisone or placebo within six hours of trauma exposure

Single dose

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 2, 6, 12, and 28 weeks post-treatment

28 weeks

4 visits (in-person)

Treatment Details

Interventions

• Hydrocortisone (Corticosteroid)
• Placebo (Other)

Trial Overview The study tests if a single dose of hydrocortisone (HCORT), given within six hours after trauma can prevent PTSD compared to a placebo. It's randomized with assessments at multiple intervals post-treatment to measure the decline in PTSD symptoms and related mental health issues.

Participant Groups

Group I: HCORT Active Control 1 Intervention

180 mg capsule PO

Group II: Placebo Placebo Group 1 Intervention

matching capsule PO

Hydrocortisone is already approved in Canada for the following indications:

Approved in Canada as Hydrocortisone for:

• Adrenal insufficiency
• Allergic reactions
• Asthma
• Severe acute pancreatitis

Who Is Running the Clinical Trial?

Rachel Yehuda

Lead Sponsor

Trials

2

Recruited

320+

The Chaim Sheba Medical Center

Collaborator

Trials

20

Recruited

7,400+

James J. Peters Veterans Affairs Medical Center

Collaborator

Trials

59

Recruited

2,900+

Dr. Balavankatesh Kanna

James J. Peters Veterans Affairs Medical Center

Chief Executive Officer since 2022

MD from Coimbatore Medical College, MPH from Johns Hopkins Bloomberg School of Public Health

Dr. Meenakshi Zaidi

James J. Peters Veterans Affairs Medical Center

Chief Medical Officer since 2017

MD, Fellow of the American College of Physicians

Findings from Research

In a study of 63 male veterans, oral administration of 20mg hydrocortisone reduced the fear-potentiated startle response, indicating a potential fear-inhibiting effect of cortisol.

The reduction in startle responses occurred regardless of whether the veterans had PTSD, suggesting that hydrocortisone may influence the body's stress response system, which could help in understanding resilience to traumatic stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hydrocortisone suppression of the fear-potentiated startle response and posttraumatic stress disorder. Miller, MW., McKinney, AE., Kanter, FS., et al.[2021]

In a pilot study involving 24 military veterans, hydrocortisone augmentation during prolonged exposure therapy for PTSD led to greater symptom reduction and improved patient retention compared to a placebo, suggesting it may enhance treatment efficacy.

The study found that veterans who responded positively to hydrocortisone had higher glucocorticoid sensitivity before treatment, indicating that measuring glucocorticoid responsiveness could help identify patients who might benefit most from this combined therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Yehuda, R., Bierer, LM., Pratchett, LC., et al.[2022]

A single intravenous dose of hydrocortisone given within 6 hours after a traumatic event did not significantly reduce the incidence of PTSD compared to a placebo in a study of 118 patients.

However, administering hydrocortisone at night, when cortisol levels are naturally lower, showed a potential reduction in PTSD prevalence, indicating a need for further research in this specific timing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hydrocortisone in the emergency department: a prospective, double-blind, randomized, controlled posttraumatic stress disorder study. Hydrocortisone during golden hours. Carmi, L., Zohar, J., Weissman, T., et al.[2022]

In a trial involving women with chronic PTSD, the CRHR1 antagonist GSK561679 did not show significant improvement compared to placebo, highlighting the challenge of achieving drug efficacy in the presence of strong placebo effects.

A substantial placebo effect was observed, with effect sizes up to 1.5 standard deviations, indicating that the structure and support of the clinical trial itself may have contributed to improvements in PTSD symptoms and cognitive performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Placebo Effects Across Self-Report, Clinician Rating, and Objective Performance Tasks Among Women With Post-Traumatic Stress Disorder: Investigation of Placebo Response in a Pharmacological Treatment Study of Post-Traumatic Stress Disorder. Hodgins, GE., Blommel, JG., Dunlop, BW., et al.[2022]

A 10-day low-dose course of hydrocortisone (20 mg twice daily) significantly reduced PTSD and depression symptoms in 64 traumatic injury patients compared to a placebo, indicating its potential efficacy in preventing post-traumatic stress disorder.

Patients who had never received prior mental health treatment showed the greatest benefits, suggesting that hydrocortisone may be especially effective for those without a history of significant psychological issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: a randomized trial. Delahanty, DL., Gabert-Quillen, C., Ostrowski, SA., et al.[2021]

Hydrocortisone significantly reduces PTSD symptoms and incidence compared to placebo, based on a meta-analysis of 8 studies involving 362 participants, with a strong effect observed when used preventatively.

While hydrocortisone shows promise as a low-cost treatment for preventing PTSD, the limited number of studies and their methodological quality highlight the need for more rigorous research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hydrocortisone administration for reducing post-traumatic stress symptoms: A systematic review and meta-analysis. Kothgassner, OD., Pellegrini, M., Goreis, A., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Hydrocortisone suppression of the fear-potentiated startle response and posttraumatic stress disorder. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Hydrocortisone in the emergency department: a prospective, double-blind, randomized, controlled posttraumatic stress disorder study. Hydrocortisone during golden hours. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Placebo Effects Across Self-Report, Clinician Rating, and Objective Performance Tasks Among Women With Post-Traumatic Stress Disorder: Investigation of Placebo Response in a Pharmacological Treatment Study of Post-Traumatic Stress Disorder. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: a randomized trial. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Hydrocortisone administration for reducing post-traumatic stress symptoms: A systematic review and meta-analysis. [2022]