What if a single needle prick cured post-traumatic stress? Or an ancient remedy stopped suicidal thoughts? Or virtual reality replaced traditional therapy?
What may seem like far-fetched ideas now could become viable treatment options not too far into the future.
These are just a few of the cutting-edge approaches military researchers are exploring to better treat post-traumatic stress and suicidal ideation that Robert McLay, research director for the Naval Medical Center, San Diego, shared during the 2013 Warrior Resilience Conference. The virtual conference was held in August.
“It sounds like fantasy,” McLay said. “But this stuff looks really promising.”
PTSD can develop after a traumatic or life-threatening event and is characterized by ongoing nightmares or flashbacks of the event, feelings of fear, guilt or shame, jumpiness or alertness, and trouble sleeping. The National Center for PTSD estimates that 11 to 20 percent of veterans of the Iraq and Afghanistan wars live with PTSD. Suicide risk is higher in people with PTSD.
According to the July 2013 Medical Surveillance Monthly Report by the Armed Forces Surveillance Center, mental disorders are the leading cause of hospital bed stays and the second leading cause of medical encounters for active-duty servicemembers, largely due to increases in hospitalizations for PTSD and depression.
Although troops have left Iraq and the conflict in Afghanistan is winding down, PTSD will continue to be a problem. Several studies of veterans suggest that while PTSD symptoms usually start soon after the traumatic event, they also may not appear until months or years later.
Help and hope are available.
There are many evidence-based treatments such as cognitive processing therapy, prolonged exposure therapy and selective serotonin reuptake inhibitors available to treat PTSD and related problems. Cognitive processing therapy provides new skills to handle distressing thoughts and to process traumatic events. Exposure therapy helps decrease distress about trauma through repeated exposure to trauma-related feelings to help reduce the power they have to cause distress. Selective serotonin reuptake inhibitors are antidepressants that treat some symptoms of PTSD.
McLay cautioned that these current interventions should be tried first, before the more innovative interventions.
“We know these current treatments really work, but we also know there are servicemembers out there who are not helped by them,” he said. “We need to look at new technology and options. We need to give these servicemembers a helping hand.”
Here are a few of the latest research endeavors happening at the Naval Medical Center, San Diego.
Stellate ganglion block. This procedure involves injecting a local anesthetic into the stellate ganglion, which is a ball of nerves in the neck where the “flight or fight” signals from the brain go out to the body. Stellate ganglion block has been used for a long time to ease pain, but now researchers are learning that it also seems to reduce post-traumatic stress. In a pilot study by the center, patients experienced significant drops in post-traumatic symptoms; however, effects faded with time. Research on dosage amounts continues.
Transcranial magnetic stimulation. Brain scans show changes in brains with PTSD. The brain is a neurochemical circuit and post-traumatic stress disturbs this circuit, resulting in changes based on the electrical charge of the brain. Transcranial magnetic stimulation is a new technology that can change the brain’s charge. It already has been approved for use in treating depression. Early studies by the center showed a significant drop in post-traumatic stress symptoms in half of the patients in the study. The improvements gained from the noninvasive method wear off, but they are not completely reversed. Research into this technology continues.
Attention retraining. This computer-based method focuses on how patients look at and respond to different stimuli. The goal is to train patients not to focus on anxiety-inducing or negative thoughts, events or situations. This method is used to treat other anxiety conditions and may be effective for PTSD. The center showed in a recent study that although patients improved with attention retraining, they often did not continue the treatment as directed, and the gains were lost.
Virtual reality assisted exposure therapy. This intervention builds upon exposure therapy, which is considered currently to be the most effective treatment for PTSD. This therapy creates a realistic, anxiety-provoking simulation that teaches patients to overcome their fears by facing them and talking about them. It aims to make exposure therapy more engaging and effective by using virtual reality as an alternative to traditional methods. Clinical trials at the Virtual Reality Medical Center in San Diego showed that 50 to 75 percent of patients got better and stayed better with this therapy.
Caring letters project. This suicide prevention program sends brief, caring emails and reminders of available treatments to servicemembers following psychiatric hospitalization. Previous studies suggest that repeated, caring communication helps reduce suicide in high-risk patients. The center is conducting a two-year, multisite study of 4,730 patients to study the effect the caring letters project has on suicide rates.
Ketamine. This ancient remedy has been used in developing countries as an anesthetic for years. It also has been touted as a miraculous, short-term antidepressant. The center’s researchers have shown that ketamine may be able to help people who are at their very lowest feel better, resulting in reduced suicide and improved long-term outcomes. They studied the use of ketamine with patients with suicide ideation in emergency rooms. Research results so far have shown that most patients who received ketamine felt better almost immediately and that these improvements lasted at least two weeks. These patients experienced reduced feelings of hopelessness, depression and suicidality. The center is conducting more ketamine clinical trials.
Time will tell which of these studies will prevail and lead to successful treatments that can be used at the home front and at the frontline. Regardless, these latest advances in technology and research show more innovative, life-saving treatments are around the corner.
“We have shown that we can do something,” McLay said. “There is hope.” ♦
Dana Crudo is a staff writer for www.health.mil.
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- Volume: 18