What Are The New Treatments Available For PTSD?

What is PTSD? 

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in individuals who have either experienced or witnessed a terrifying event. It can be debilitating, resulting in insomnia, flashbacks, nightmares, and avoidance of triggers — which can significantly interfere with normal life. 

Currently, there is no single cure that works for everyone with PTSD. However, symptoms can be managed with several effective treatments to enable the individual to return to normal functioning and possibly become symptom-free. 

How is PTSD conventionally treated? 

Generally, PTSD is treated with therapy, medication, or a combination of the two. While this approach can be highly effective for some individuals, remission rates remain high at around 30–40%.¹ 

Despite the high prevalence of PTSD (estimated at around 30%² of populations in areas of conflict), research into the most effective therapies remains surprisingly limited. The effects of treatment between individuals can be highly variable. There is often low compliance with medication or therapy, contributing to this variability. 

Therapy options with the strongest evidence base include cognitive behavior therapy (CBT) and eye movement desensitization and reprocessing (EMDR). Conventional drugs administered for PTSD are antidepressants, mainly sertraline and paroxetine. 

The stigma around PTSD remains high, leaving individuals misunderstood and seen as dangerous, incompetent, or responsible for their condition. 

Stigma has been identified as contributing to increased helplessness and reduced functional recovery in some individuals with PTSD. As a result, there is a growing need to change the way PTSD is both understood and treated — particularly for those who aren’t responding to traditional medicine. 

New treatments being investigated

MDMA therapy

When administered, MDMA increases levels of serotonin, dopamine, norepinephrine, and oxytocin. It also reduces amygdala activity in response to negative stimuli and increases connectivity between the amygdala and the hippocampus. 

What does this mean in terms of how you will feel? Taking MDMA can give you more energy, reduce anxiety, increase your empathy and touch sensitivity, distort your time perception, and allow you to open up about your emotions. 

A double-blinded, randomized, placebo-controlled trial³ investigated the efficacy of MDMA-assisted therapy for severe PTSD for 18 weeks. The study found that MDMA-assisted therapy is highly effective at attenuating symptoms of PTSD and functional impairment. It was also still effective in individuals with comorbidities, including depression, dissociation, and substance abuse. 

The study also identified that MDMA had a greater effect on lowering the Clinician-Administered PTSD Scale (CAPS-IV) when compared with paroxetine and sertraline in other studies. Further studies will be required to directly compare the effects of these different medications. 

The study identified that the side effects were transient and relatively modest. Some patients experienced muscle soreness, nausea, feeling cold, and a loss of appetite.

How does it work? 

It is thought that through taking MDMA, alongside therapy, individuals can access and process traumatic content without being overwhelmed or experiencing dissociative symptoms. Some believe that MDMA may help to reduce the shame and anger around the events that have caused PTSD and see them with more self-compassion. 

This means that memories become more accessible, allowing for more productive therapy sessions. 

Stellate ganglion block 

A stellate ganglion block is an injection of local anesthetic that goes into the neck, targeting the sympathetic nervous system. 

The stellate ganglion is a collection of nerves that supply the face and arm. It is commonly administered to reduce head, neck, arms, or chest pain. Recent research has identified that it may have the potential as a treatment option for PTSD. 

A benefit of this approach to treating PTSD is that it may destigmatize the condition by focusing on its biological components. 

A randomized trial⁴ investigated the administration of two stellate ganglion blocks for treatments two weeks apart. It found that PTSD symptoms, according to the DSM-5 criteria, were significantly reduced at an eight-week follow-up. 

While further research is required to assess if and how these effects persist beyond eight weeks, these preliminary findings are encouraging. 

This procedure does have some potential risks — however, they occur infrequently. These include seizures, numbing of the arm that lasts for hours, nerve damage, and bruising at the injection site. 

How does it work?

The exact mechanism of how this works is yet to be determined, as we do not fully understand the pathology of PTSD. So far, we know about the involvement of the sympathetic nervous system and the amygdala. 

The sympathetic nervous system is your body’s fight or flight system, helping you to react to danger or stressors. In PTSD, this can remain activated for extended periods. By injecting an anesthetic into the sympathetic nervous system, the fight-or-flight response can be turned off for a few hours. 

This then allows the brain to adjust to the restful state, providing immediate and long-acting relief of symptoms. 

The amygdala, your fear center in the brain, is attached to the stellate ganglion and is also abnormally activated in PTSD. Inhibiting the stellate ganglion enables reduced activation of the amygdala, contributing to the therapeutic benefit of this treatment. 

You may find that following the injection, your eyes droop, your voice becomes hoarse, and your face feels warm. 

Virtual reality 

A systematic review⁵ conducted in 2021 found that treating PTSD with virtual reality is highly effective, comparable with traditional medicine, and may be a great option for those who haven’t responded to conventional methods. So far, research has not found treatment with virtual reality to be more effective than other trauma-focused treatments. However, some studies have found that virtual reality is still effective in patients who have previously been treatment-resistant. 

It may be a more realistic option for patients who aren’t willing to participate in psychotherapy. Previous research has identified that 33% of American soldiers were unwilling to talk to a counselor but were open to using technology-based therapy. 

How does it work? 

Many patients find it hard to visualize the traumatic event during therapy sessions. But it is important that they confront the event, as it can help remove their heightened response to it. This is where virtual reality may be able to address this gap by gradually exposing individuals to a controlled, engaging environment. 

This method can allow therapists to gradually increase the number of challenges their patient is exposed to and repeat exposure as often as necessary. 

The lowdown

PTSD is a complex and debilitating condition. With more research and education underway, an understanding of the mechanisms of PTSD will continue to grow. 

Psychotherapy and medication are already known to be effective for some individuals, but it is important to encourage further research that looks at options for those who are treatment-resistant. You may want to consider asking your doctor about these new treatments if you have not responded to conventional methods. 

Keep in mind that PTSD is not something you need to tackle on your own. Look out for local support groups, talk to your friends, and keep an eye on emerging research for the best treatment options.