Illustration: Aïda Amer/Axios
Post-traumatic stress disorder is proving to be an elusive condition to treat, but researchers are increasingly chipping away at new and better treatments.
Why it matters: PTSD is estimated to affect 7 or 8 people out of every 100, and the World Health Organization reported recently that more than 1 out of every 5 people who have been in conflict settings face mental disorders, including PTSD — a greater number than originally expected.
By the numbers: The WHO paper, published in The Lancet, examines data from 129 studies and finds...
- 22% of people living in conflict areas have depression, anxiety, PTSD, bipolar disorder or schizophrenia.
- Women are more likely to be affected than men.
- 13% of the population has a mild form of the disorder, while about 9% have moderate to severe disorders.
The backdrop: Military service members and emergency personnel are not the only people who face PTSD — anyone who has survived a distressing event or chronic childhood trauma can experience the disorder, now recognized as "a real source of impairment" for people, says Franklin Schneier, special lecturer in psychiatry at Columbia University Irving Medical Center.
- It tends to be characterized by intrusive symptoms that can include frequent flashbacks, nightmares, avoidance of reminders, hyperarousal or over-vigilance, and extended negative thinking, Wayne State University's Arash Javanbakht tells Axios.
- PTSD often is accompanied by depression, anxiety and sometimes suicidal thoughts.
- But, not everyone who experienced the same trauma ends up having the disorder, which has led to examination of heritability, including small studies on a possible link to a genetic variant in the CACNA1C gene and on a biomarker that may be associated with a greater risk of suicidal thoughts.
In recent years, brain scans have linked PTSD to brain shrinkage and lesions, Javanbakht says, although he adds scans aren't used for clinical diagnosis.
- The most prevalent treatments now tend to be a combination of cognitive processing therapy or prolonged exposure therapy with medications that treat anxiety, depression, physical agitation, nightmares and other sleep problems.
What they're saying: Edna Foa, professor of psychiatry at the University of Pennsylvania's Perelman School of Medicine, says "at this point, the best treatment we have that's more reliable" is exposure and response prevention therapy combined with drugs.
- Recent research conducted by Foa's team shows that for PTSD and its cousin, obsessive compulsive disorder, positive results will last longer with more sessions. She recommends 22 or 25, rather than than the 15 typically prescribed.
- More research is needed to wean people off the medications, too, she adds.
The latest: As Axios noted in its recent Deep Dive on neuroscience, psychologists are examining the brain's forgetting strategies to see if they can be used to help people discard or diminish the memories that cause trauma — or at least associate them with more positive feelings.
- One new way to do that could be the use of virtual reality (VR) or augmented reality (AR) to help with exposure therapy. Javanbakh tells Axios his clinic has been "very successful" in treating spider phobias with AR and telepsychiatry. While it's still in its early days (they are developing a proof of concept), he believes this will also apply to people with PTSD.
- Some apps are popping up, too. NightWare, which is enrolling people in randomized clinical trials after receiving FDA's Breakthrough Status designation, is an Apple Watch app that would vibrate to interrupt someone's nightmare, without waking the wearer.
- "There's interest in [apps] but not a lot of hard data showing the effectiveness of these," Schneier says. He "sees promise" in VR and AR tools — "but whether that's a breakthrough or simply a better way to do exposure therapy is not yet known."
Doctors are looking for new medications, too, Schneier says. Some research has targeted the possible use of ketamine or similar drugs, but the problem seems to be the fix is temporary, it could be addictive and has other side effects, he says.
- Seth Lederman, CEO of Tonix Pharmaceutical, tells Axios his company is currently in Phase 3 trial of Tonmya, which aims to help improve the sleep quality of a person with PTSD with a non-addictive formula. "We think that is a key mechanism of improving PTSD," Lederman says.
- He adds that they've found that it's important to treat PTSD within 9 years of the trauma incident, if possible. "What happens over time, effectively, is that the brain becomes scarred. Once you get that scarring, you lose the plasticity" that helps recovery, he says.
- The unseen, uncounted toll of America's wars
- Looking at ketamine, the short-term wonder antidepressant
- The flimsy promises of brain wearables
The National Suicide Prevention Lifeline is 1-800-273-8255.