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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.

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.

Go deeper:

The National Suicide Prevention Lifeline is 1-800-273-8255.

Go deeper

Updated 41 mins ago - Health

California surpasses 50,000 COVID-19 deaths

A man prepares a funeral arrangement in in Los Angeles, California, Feb. 12. Photo: Mario Tama/Getty Images

California's death toll from COVID-19 surpassed 50,000 on Wednesday, per Johns Hopkins data.

The big picture: It's the first state to record more than 50,000 deaths from the coronavirus.

2 hours ago - Technology

Facebook bans Myanmar military

A protester holds a placard with a three-finger salute in front of a military tank parked aside the street in front of the Central Bank building during a demonstration in Yangon, Myanmar. Photo by Aung Kyaw Htet/SOPA Images/LightRocket via Getty Images

Facebook said on Wednesday it would ban the rest of the Myanmar military from its platform.

The big picture: It comes some three weeks after the military overthrew the civilian government in a coup and detained leader Aung San Suu Kyi, causing massive protests to erupt throughout the country. Military leaders have been using internet blackouts to try to maintain power in light of the coup.

It's harder to fill the Cabinet

Data: Chamberlain, 2020, "United States of America Cabinet Appointments Dataset" Chart: Will Chase/Axios

It's harder now for presidents to win Senate confirmation for their Cabinet picks, an Axios data analysis of votes for and against nominees found.

Why it matters: It's not just Neera Tanden. The trend is a product of growing polarization, rougher political discourse and slimming Senate majorities, experts say. It means some of the nation's most vital federal agencies go without a leader and the legislative authority that comes with one.