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Steven M. Southwick, MD; John H. Krystal, MD; C. Andrew Morgan, MD; David Johnson, PhD; Linda M. Nagy, MD; Andreas Nicolaou, PhD; George R. Heninger, MD; Dennis S. Charney, MD

Arch Gen Psychiatry. 1993;50(4):266-274.

Abstract
• To evaluate possible abnormal noradrenergic neuronal regulation in patients with posttraumatic stress disorder (PTSD), the behavioral, biochemical, and cardiovascular effects of intravenous yohimbine hydrochloride (0.4 mg/kg) were determined in 18 healthy male subjects and 20 male patients with PTSD. A subgroup of patients with PTSD were observed to experience yohimbine-induced panic attacks (70% [14/20]) and flashbacks (40% [8/20]), and they had larger yohimbine-induced increases in plasma 3-methoxy-4-hydroxyphenylglycol levels, sitting systolic blood pressure, and heart rate than those in healthy subjects. In addition, in the patients with PTSD, yohimbine induced significant increases in core PTSD symptoms, such as intrusive traumatic thoughts, emotional numbing, and grief. These data were consistent with a large body of preclinical data that indicated that uncontrollable stress produces substantial increases in noradrenergic neuronal function. We discuss the implications of these abnormalities in noradrenergic functional regulation in relation to the long-term neurobiological sequelae of severe uncontrollable stress and the pathophysiological relationship between PTSD and other anxiety disorders, such as panic disorder.

Author Affiliations
From the National Center for Post Traumatic Stress Disorder, West Haven (Conn) Veterans Affairs Medical Center (Drs Southwick, Krystal, Morgan, Johnson, Nagy, Nicolau, and Charney), and the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn (Drs Southwick, Krystal, Morgan, Johnson, Nagy, Heninger, and Charney).

Footnotes
Accepted for publication July 30, 1992.

Reprint requests to Department of Veterans Affairs, Medical Center, 950 Campbell Ave, West Haven, CT 06516 (Dr Southwick).

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