Post Traumatic Stress impacts more people that we might think

Post Traumatic Stress. The condition came to light when members of our military returning from the “theatre” of war and they were diagnosed with a distinct syndrome which is now recognized as a medical condition. It does not mean that it is anything new. For decades it was called shell shock or combat fatigue. Post-Traumatic Stress is not just for military veterans. Civilians live with the condition too. In modern times, there are examples all around us like the first responsders during 9/11, survivors of mass shootings in Las Vegas, Sandy Hook, Parkland and countless others, or even survivors of natural disasters from the fires in Paradise, California or Hurricanes Katrina (New Orleans), Michael (Florida Panhandle) or Maria (Bahamas & Puerto Rico).

Soon there will be more in these ranks as a result of the COVID-19 pandemic. This can include the those on the front line in healthcare, first responders and even those afflicted with the virus. PTS can also be sourced from individual experiences like a devastating car accident, a life changing rape or a fall down a 40-ft embankment that left me paralyzed more than two decades ago. Anyone who has been through a drastically tragic event understands how the smallest of outside influences can trigger a memory and spark a physiological response.

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June is Post-Traumatic Stress awareness month. It is a time to not only learn about the condition, but to become empathetic to the symptoms and to take note of potenial treatments. According to the National Institute of Mental Health, approximately 3.6% of adults in the U.S. had PTS in the last year. It is estimated that there are about 8 million people living with the condition today. The condition is more prevalent among war veterans at a rate of 10–25%. It is also more prevalent among women.

The condition can emerge from a dangerous or traumatic event that is more than a typical stress induced occurence. Most people are exposed to such events at least once in their lifetime and typically overcome the traumatic event within six months to a year. Post-traumatic stress condition is different with a combination of persistent feelings of socially isolated, detachment, frightening thoughts or flashbacks that interrupt daily living including work and relationships. Typically, a psychiatrist or psychologist will conduct the assessment and diagnosis. Symptoms of post-traumatic stress can be masked and not surface for months. The condition typically is accompanied by anxiety, sleep problems, substance abuse and/or depression.

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Even though there are many people living with the condition, it is often disguised by other symptoms of the condition or not at all, particularly in an American society that tends to brush over mental health. Since it is now recognized as a medical condition, therapies, treatment protocols and diagnostics are being developed for better outcomes.

The standard treatment for PTS is psychotherapy such as cognitive behavior therapy or exposure therapy along with medications such as antidepressants. There are emerging therapies in neurotechnology that may help specifically with post-traumatic stress. One such technology is repetitive transcranial magnetic stimulation. The technology is FDA approved for treatment resistant depression and pain management. Some clinical trials have been conducted. A randomized control trial compared those who received rTMS combined with cognitivie processing therapy and those with CPT alone. The results demonstrated that those in the combined group had reduced symptoms of PTS up to six months post-treatment. The study was led by Andrew Kozel from the University of South Florida. Yet, in another study lead by Jerome Yesavage from the Palo Alto VA and Stanford University had results that yielded no difference between the groups that received rTMS and those who received sham treatments. To date, the results on inconclusive.

There is a therapy using deep transcranial magnetic stimulation (dTMS) for the treatment of PTSD. It has a CE mark approval in Europe but is not approved yet by the U.S. FDA. The therapy is offered by BrainsWay and involves a series of outpatient stimulation procedures. The dTMS treatment targets specific brain structures related to PTSD, which involve placing the stimulation coil over the patient’s head in the specific target region. It is a non-invasive procedure.

Another non-invasive modality being explored is vagus nerve stimulation (VNS). VNS has been FDA approved/cleared for the treatment of epilepsy, treatment resistant depression, withdrawal symptoms for addiction, as well as migraine and cluster headaches. Evren Technologies is developing an ear-bud wearable to treat PTSD. The company is currently recruiting people living with PTSD to try the prototype device as a home-based therapy. They are also seeking people to serve on their consumer advisory board. More information is available on the Evren Technologies website.

Traditional treatments for PTSD and other mental health conditions typically include medications. Finding that right drug ‘cocktail’ tends to be a trial-and-error process that can have life changing consequences. PEER Analytics is a commercial assessment tool using statistical intelligence to find an individualized medication combination. The system uses data from an EEG reading of the person’s brain and compares a national dataset to determine a recommended medication. The use of non-invasive EEG to guide treatment options is an example of combining pharmaceuticals and neurotechnology to improve treatment protocols.

Other modalities that are being investigated specifically for PTSD include transcranial direct current stimulation (tDCS), theta-burst stimulation (TBS), and deep brain stimulation (DBS). Another promising therapy is the use of virtual reality therapy. Here are some additional clinical trials that involve neurotech interventional treatments some have results posted online. More information about these trials and results are available on Clinicaltrials.gov

  • Theta-Burst Neuromodulation for PTSD: This study is sponsored by the VA Office of Research and Development and conducted at the Providence (RI)VA Medical Center. The feasibility study is to explore the treatment procedure using TBS and how it impacts symptoms of PTSD and quality of life. Ultimately the results will lead to brain stimulation techniques that can be combined with evidence-based psychotherapy, to develop a more powerful, individualized rehabilitation option for Veterans with PTSD. Identifier: NCT02769312
  • Cranial Electrotherapy Stimulation in Burned Patients: This was a small study evaluating the effectiveness of cranial eletrotherapy in managing post-traumatic stress disorder (PTSD) in people who are receiving rehabilitation treatments in a burn center. The study is sponsored by the United States Army Institute of Surgical Research. Identifier: NCT00723008
  • Deep Brain Stimulation of the Amygdala for Combat Post-Traumatic Stress Disorder: This study is sponsored by the VA Greater Los Angeles Healthcare System. The goal is to develop a new therapeutic strategy involving the placement of intracranial electrodes in the brain. The project is based on recent evidence showing abnormal activity in a specific brain region are thought to be responsible for the core symptoms of PTSD. Identifier: NCT02091843
  • Post-traumatic Stress Disorder Treatment Using Transcranial Direct Current Stimulation (tDCS) Enhancement of Trauma-focused Therapy: a Two-arm Randomized Controlled Multicentric Study (T-TREAt): This study is being conducted at University Hospital in Tours, France. This project aims to assess the efficacy of a less known but promising therapeutic strategy for PTSD : the use of transcranial Direct-Current Stimulation (tDCS) to enhance the trauma-focused therapy results. Identifier: NCT02900053
  • Deep Brain Stimulation for Treatment Refractory PTSD: This is a pilot study sponsored by Sunnybrook Health Sciences Centre. It is a safety and efficacy study to explore a surgical therapy for refractory PTSD using deep brain stimulation and targeting the subgenual cingulate region which is also targeted for the treatment of depression. Identifier: NCT03416894
  • tDCS Plus Virtual Reality for PTSD (TAVRE): This effectiveness study combines transcranial direct current stimulation (tDCS) with virtual reality exposure as a treatment for Veterans with chronic posttraumatic stress disorder (PTSD). Researchers at the Providence (RI) VA Medical Center are testing whether this intervention improves PTSD symptoms and improves quality of life. Identifier: NCT03372460

Today, the neurotechnology therapies specifically for post-traumatic stress disorder is a growing field, particularly for non-invasive technology. It may seem that there are not many neurotech solutions just for PTSD. There are approved or cleared devices for specific symptoms of the condition, such as anxiety, depression or sleep disruption.

Neurotech Network offers free resources and a directory of devices specifically for post-traumatic stress as well as related symptoms. Check out our resource page here.

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The content for this article was provided by Neurotech Network. The source of references include the World Health Organization, National Institutes of Mental Health and clinicaltrials.gov.

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Other references:

Gouveia, FV, Gidyk DC, et al. Neuromodulation Strategies in Post-Traumatic Stress Disorder: from preclinical models to clinical applications. Brain Sci. 2019 Feb; 9(2): 45.PMID: 30791469

Kozel, FA, Motes, MA, et al. Repetitive TMS to Augment Cognitive Processing Therapy in Combat Veterans of Recent Conflicts with PTSD: A Randomized Clinical Trial. J Affect Disorder. 2018 Mar 15;229:506–514. PMID: 29351885

Novakovic V, Sher L, et al. Brain Stimulation in posttraumatic stress disorder. Eur J Psychotraumatol. 2011; 2: 10.PMID: 22893803

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