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Steven M. Southwick, MD; John H. Krystal, MD; J. Douglas Bremner, MD; C. A. Morgan III, MD; Andreas L. Nicolaou, PhD; Linda M. Nagy, MD; David R. Johnson, PhD; George R. Heninger, MD; Dennis S. Charney, MD

Arch Gen Psychiatry. 1997;54(8):749-758.

Abstract
Background
Yohimbine hydrochloride produces marked behavioral and cardiovascular effects in combat veterans with posttraumatic stress disorder (PTSD). In the present study, yohimbine was used as a probe of noradrenergic activity, and meta-chlorophenylpiperazine (m-CPP) as a probe of serotonergic activity. To our knowledge, this is the first study to describe the behavioral and cardiovascular effects of meta-CPP in patients with PTSD, and to compare these effects with those of yohimbine.

Method
Twenty-six patients with PTSD and 14 healthy subjects each received an intravenous infusion of yohimbine hydrochloride (0.4 mg/kg), m-CPP (1.0 mg/kg), or saline solution on 3 separate test days in a randomized balanced order and in double-blind fashion. Behavioral and cardiovascular measurements were determined at multiple times.

Results
Eleven (42%) of the patients with PTSD experienced yohimbine-induced panic attacks and had significantly greater increases compared with controls in anxiety, panic, and PTSD symptoms, but not in cardiovascular measurements. Eight patients (31%) with PTSD experienced m-CPP-induced panic attacks and had significantly greater increases compared with controls in anxiety, panic, and PTSD symptoms, and in standing diastolic blood pressure. Yohimbine-induced panic attacks tended to occur in different patients from m-CPPinduced panic attacks.

Conclusion
These data suggest the presence of 2 neurobiological subgroups of patients with PTSD, one with a sensitized noradrenergic system, and the other with a sensitized serotonergic system.

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

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