PTSD and treatment

by Jacquelyn Harvey, GCSOM, MBS 2019
Mentor: Dr. Brian Piper, PhD

Following the tragedy of 9/11 and the start of the War in Afghanistan, the U.S. once again entered wartime leading to thousands of soldiers to return home with trauma from combat. The number of soldiers with Post-traumatic stress disorder (PTSD) brought on by combat-associated events has increased since 2001. Research on drug therapies since then have focused on the differing approaches to the disorder, with still much left unknown.

PTSD is defined as a trauma disorder of mental health. The condition includes exposure to a life-threatening event, as unfortunately frequently witnessed during combat. Patients experience some form reliving the event and avoidance with negative changes in thinking and mood, and increased reaction to stimuli. This can cause veterans an inability to function in daily life for greater than or equal to one month in duration. It is believed that fear responses associated with “fight or flight” are in play with this disorder. This nervous system response is what causes humans to either prepare or flee from a possible threatening situation. Brain areas responsible for this response are thought to be overactive in symptoms of PTSD.

PTSD is a long-lived condition and associated with poor quality of life and high personal social and economic costs. In previous wars it was known as “shell shock”. The US economy loses approximately 3 billion dollars every year due to PTSD. PTSD is very prevalent at 8-10% in the general population, with an even higher percentage amongst combat veterans 6-31%. Combat veterans are less responsive to treatment related to the intensity of event: whether there was death exposure, injury, torture or brain injury. There is also a risk factor in patients with PTSD for other problems such as other mental health and drinking problems. There are substantial gaps in knowledge regarding best management and treatment of patients diagnosed with PTSD, as well as a lack of veterans seeking treatment to a variety of different reasons.

Current strategies of treatment include drugs and therapy. A class of drugs that is considered the go-to in the clinic are called SSRIs (selective-serotonin reuptake inhibitors) despite research not showing them as the best option. Therapy is encouraged in the form of cognitive-behavioral therapy (CBT). There are multiple techniques which a therapist or counselor can use to help the patient deal with their uncomfortable symptoms. Therapists also provide an outlet for the veteran to talk about their experience if helpful. However, therapy can be difficult in terms of access and motivation to start and continue. Regardless, it is important that veterans feel they can communicate feelings about traumatic events that cause them distress. Most clinicians and research points towards a combination of treatment of drugs and therapy. Many patients are finding mindfulness training to be an additional and alternative technique. This tool helps the patient to revisit memories with a no judgment while staying present (knowing that they are in no immediate danger).

PTSD deals with multiple factors. In general there needs to be more acceptance of conversation and public education about mental health in general and the need for more professionals in this area. Future research is going to focus on alternative methods to drugs to be used with medicine and therapy. Additionally, there are more drugs and therapeutic techniques to be tried. We owe it to our veterans to provide the best care possible when they return home.