November 10, 2016 – In the United States, roughly 8 million people suffer from post-traumatic stress disorder, or PTSD, every year. Many may be helped with a mixture of talk therapy and drugs. But this mixture, considered the gold standard for treating the disorder, doesn't work for everybody. Four experts describe essentially the most promising latest treatments currently being studied. On their list:
Exposure therapy with virtual reality. The use of virtual reality is a latest variation on a type of treatment called prolonged exposure therapy. The traditional form involves exposing an individual with PTSD to things or events they avoid due to trauma related to them for an prolonged time frame. Some experts say adding the virtual reality component could work even higher.
A pc simulation may be used to breed smells, sounds and pictures related to the trauma. After the experience, patients speak about it with their therapist.
“You create a scenario where you help the patient recreate the experience in a controlled environment and address the feelings and thoughts associated with it,” says Dr. Daniella David, chief of psychiatry on the Miami VA Healthcare System. “It helps people process the emotions.”
“It appears to be stronger [than exposure therapy alone]”, says Spencer Eth, MD, director of psychiatric services at the Miami VA.
But a recent report found that while the therapy seems promising, there's limited evidence of how well it works. And there's no good study comparing traditional exposure therapy with virtual reality, says Matthew Friedman, MD, PhD, former executive director of the VA National Center for PTSD. Exposure therapy of any kind is best supervised by a trained therapist, experts say.
Ketamine. This drug is used as an anesthetic and is being tested as an experimental treatment for depression that doesn't respond to other treatments. It may also help with PTSD, says Adriana Feder, MD, associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai. In one study, Feder and colleagues gave people with PTSD ketamine intravenously. The treatment showed fewer PTSD symptoms 24 hours later than another anesthetic, midazolam (Versed). But the study was small, involving only 41 patients. Feder says the drug can distort users' perception of sights and sounds, causing a feeling of detachment for a short time.
Prevention. Some experts try to prevent PTSD before it happens. They may do this by using medication, talk therapy, or both soon after the trauma. Scientists are studying a number of drugs, including the high blood pressure drug propranolol, Friedman says. It may dull the emotional aspects of the memory. The drug can't be taken by everyone, even people with low blood pressure.
Mindfulness. Mindfulness therapy can ease the anxiety and feelings of tension that PTSD sufferers experience, some experts say. The approach is now widely accepted and helps people without PTSD reduce stress and anxiety. It includes meditation exercises such as sitting and focusing on breathing to be “within the moment.”
“What happened, happened,” says Friedman. “You can't undo it. The mindfulness approach takes that into consideration and provides you tools to have a look at what happened and process it another way.”
Other approaches. Some researchers are looking into magnetic resonance therapy (MRI), also known as “brain zapping.” A coil sends a pulsed magnetic field to the brain to “retune” it and its responses. It's not clear how this might help control mood and depression. A small clinical trial of this approach is currently underway.
Researchers have also studied medical marijuana, but individuals with PTSD could also be at increased risk for using drugs, including marijuana, Eth says. Another approach is studying resilient individuals who will not be as affected by trauma and what they will teach others, Friedman says.
Half of all people within the U.S. might be exposed to serious trauma during their lifetime, Friedman says. Most people don't develop PTSD, but for many who do, it's crucial that they've quite a lot of treatment options, because experts know there's nobody approach that helps everyone.
Although these latest PTSD treatments are promising, experts say they're still being investigated. Only a number of patients have been tested to this point and the study results should be reproduced before they may be used more widely.