Inside NYP: Dr. Yuval Neria

I was born and raised in Israel to a family who were basically founders of the state. My parents were in the precursor to the modern Israeli army; they were both combatants and my mother was a medic, so I was exposed to the effects of stress and trauma from a very young age.

I’ve been through two wars myself, the first as a young 21-year-old lieutenant in the Yom Kippur War in 1973, where I fought alongside friends and colleagues and where I was eventually injured. The war changed my life in so many ways. It was a tragic event and I lost my best friends, but the experience also contributed to the way I look at my life: From a very young age, I valued the opportunity I’d been given to live, to enjoy life, and to maximize my contribution to humanity.

After 9/11, Columbia University Medical Center invited me to join its Post-Traumatic Stress Disorder Program in the department of psychiatry. It was an opportunity to follow what I’d felt was my destiny from an early age, because of my experience in war. I never had PTSD, but I wanted to help those who were not able to recover or live a normal life after their military experience. What I carry with me, in addition to the horror and the fear of war, is an understanding of what patients are going through and a commitment to their treatment.

Many people with PTSD are constantly on alert; they see the world as a dangerous place. In our laboratory at NewYork-Presbyterian/Columbia University Medical Center, we use innovative neuroimaging techniques like fMRI (functional magnetic resonance imaging) to look at regions of the brain involved in identifying threats and storing memories of fearful events. What we want to know is whether these areas are different in function and structure from people who don’t have PTSD. In the past five years, we’ve been able to pretty precisely pinpoint abnormalities in how these areas are working and how they look.

 

The big problem for patients with PTSD is that only 40 to 60 percent respond to treatment. That means hundreds of thousands of vets and even more civilians with PTSD are not sufficiently helped by current treatments, and it’s not their fault. The problem is that as scientists, we haven’t figured out how to tailor the right treatment to the right person. But with our new research, we can start to see which patients might respond to which treatment by the way their brain responds, and whether a treatment is working. We’ve also started to find ways to prevent PTSD from occurring. We have recently done a study in which we’ve injected ketamine (a type of anesthetic) into mice a week before exposing them to extreme stress, and found that the drug almost completely prevented a dysfunctional fear response. The plan now is to translate this research to human beings. The idea that you might be able to make a person more resilient and resistant to trauma beforehand is a very compelling idea.

I always felt that because of my experience I have a unique story to tell and a gigantic problem to solve. Not only was I lucky enough to survive war trauma, but then I was given a rare opportunity to lead a lab in one of the best medical centers in the world, and to focus on the question of what went wrong in the brain of patients with PTSD and whether we, as scientists, can reverse it. This is very exciting and very personal for me. I am convinced the brain is plastic enough to go both ways, meaning that PTSD can be one day preventable, and even if developed, it can be effectively treated and normalized.

Dr. Yuval Neria is director of the NewYork-Presbyterian Military Family Wellness Center, professor of medical psychology at the departments of psychiatry and epidemiology at Columbia University Medical Center, and director of trauma and PTSD at the New York State Psychiatric Institute. His research is focused on clarifying clinical, behavioral, and neural signatures of trauma and PTSD. He has authored more than 180 articles and book chapters and a war novel, and co-edited four textbooks focusing on the mental health consequences of exposure to trauma.