Charles R. Marmar, MD: Blood Biomarkers for PTSD

There is a great, yet increasingly feasible, ambition to define well-evidenced blood and plasma biomarkers for the diagnosis of PTSD. To many psychiatry experts, it’s a pursuit that’s been long in the making—but still faces hurdles in the coming years.

In an interview with HCPLive during the American Psychiatric Association (APA) 2024 Annual Meeting in New York, NY, this weekend, Charles R. Marmar, MD, director of the NYU Langone department of psychiatry, discussed the history of progress in diagnosis PTSD—a practice that has been documented to as far back as Assyria, 3400 years ago.

“It was a single-case study published by the physician to the king of Assyria,” Marmar said. “And he had a patient who was a war veteran, and the war veteran was talking about having horrible experiences in which they would wake up in the middle of the night and imagine they were back on the battlefield. And the the theory of the doctor at that time was the reason the patients suffering from flashbacks to war, is that he's guilty about the enemies he's killed in battle, and the spirit of the dead enemies is coming back to haunt him.”

These symptoms, Marmar explained, correlate with the very core standard of diagnostic questions clinicians use today: “Are they having nightmares? Flashbacks? Are they jumpy and easily startled? Are they having thoughts, images, and memories that interfere with their ability to concentrate and function? Are they having difficulty falling asleep, staying asleep? And are they woken up by disturbing dreams of the traumatic event?”

Despite knowing these symptoms for thousands of years, the field is still burdened by a stigma from patients to admit their condition, Marmar said.

This issue may be eventually resolved by the advent of blood and brain imaging tests, among other biological assays under development for PTSD. Such a development may also provide psychiatrists with the first opportunity to subtype PTSD diagnoses—a finer disease definition based not only on symptoms, but molecular profiles.

From there, the opportunity may come to establish precision based medicine in PTSD.

“We want to eventually catch up with cancer and heart disease treatment,” Marmar said. “If a woman presents with breast cancer, we have precise genomic molecular features we can study and determine—based on the profile of estrogen receptors, progesterone receptors, HER-2 receptors and others—we can begin to say, 'It's this subtype of breast cancer, not that type, and therefore we would treat it with a specific monoclonal antibody.' We want to know what the molecular pathways are in PTSD that respond better to one treatment rather than another.”

^{Marmar has received support from National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental Health, Department of Defense- CDMRP, US Army Research Office, DARPA, Bank of America Foundation, Brockman Foundation, Cohen Veterans Bioscience, Cohen Veterans Network, McCormick Foundation, Home Depot Foundation, New York City Council, New York State Health, Mother Cabrini Foundation, Tilray Pharmaceuticals, Ananda Scientific, GrayMatters Health.}