Healing Combat Trauma

PTSD Symptoms Arising Sooner

A recent, likely overlooked article from US Medicine: The Voice of Federal Medicine, in September of 2005 is a good, in-depth look at one Iraq veteran's suicide and his family's interaction with veteran mental health services before, during and after.  The veteran was an Army captain, married to another Army captain, with a young baby and a brand new house.  The story is definitely one of not enough services available to be delivered in a timely manner, a horrible cost paid in human life, and some improvement after the fact, because of the brave, grieving wife's willingness to go forward and push for change.

The story makes the point that part of the reason the system is having a hard time responding to the current wave of returning veterans with PTSD is that their symptoms are coming up sooner and more severely than had been anticipated.  Hear what Dr. Matthew Friedman, executive director of VA's National Center for PTSD in White River Junction, Vt, has to say:

"Another challenge to VA clinicians is the acuteness of symptoms among veterans with adjustment reactions or PTSD, Dr. Friedman said. During the post-Vietnam era, most veterans with PTSD were considerably older and had much more chronic PTSD before they sought or received VA treatment.

"With the improvement in VA/DoD diagnosing, an increasing number of OIF/OEF returnees are requesting care at a much earlier stage in their post-traumatic clinical course.

"What's new now is that there are families [seeking help] who have returnees that came in [from deployment] one or two days ago," Dr. Friedman said.

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Importantly, there are also serious legal or insurance-related repercussions to PTSD diagnosis, or a lack thereof, which will be discussed in future posts.  The military is essentially refusing to consider a veteran's PTSD-related death from suicide to be "combat related" unless he or she has been officially diagnosed with PTSD, but making a timely appointment to be seen with symptoms arising so shortly after returning from combat has kept many veterans unable to avail themselves of the services they so desperately need.

Possible Trauma Treatment Drug

An interesting article in last Friday's Chicago Tribune (registration required) talked about the possibility of there being a pharmaceutical drug, already used for treating high blood pressure, that might have some off-label use in treating combat trauma (and other traumas as well), particularly if given within hours of exposure to the traumatic episode.  Studies are still being done on the drug, but it looks cautiously promising from the strict pharmaceutical angle.  (There are other options for treating trauma as well, that may not rely on drugs).  Some of the highlights from the article:

"Brain scientists think they have found a way to help by using a drug called propranolol to alter traumatic thoughts. It appears that the drug, a beta blocker used to treat high blood pressure, interferes with stress hormones in the brain to defuse the impact of horrific memories.  While use of the drug for this purpose has not been approved, some psychiatrists already have begun to prescribe it to patients with PTSD. (Other beta blockers do not seem to affect the brain the same way.)  "Researchers emphasize that the drug can lower the intensity of a bad memory--but not erase it."

Also,

"Dr. Roger Pitman, a professor of psychiatry at Harvard Medical School, wondered if giving propranolol as soon as possible after a traumatic event could prevent indelible, terrifying memories from taking hold.  He tested the idea on 41 people who had experienced car accidents, assaults and other events that brought them to a Massachusetts emergency room. They received the drug within six hours of their mishaps.  The results were dramatic. Three months later, 22 of the victims listened to audiotapes on which they had described their traumas. None of those who took propranolol showed strong responses to the tapes, but eight of the placebo patients were obviously shaken by reliving their experiences. Their heart rates increased, their palms sweated, their muscles twitched--all signs of PTSD.  Now Pitman's group is pursuing a study in which patients with chronic PTSD are treated repeatedly with propanolol.  "If we get positive results, there are many potential applications for people with PTSD from a variety of sources, including Hurricane Katrina and the Iraq War," Pitman said.

Wild Horses, 'Eh?

In one of the most unusual articles we've come across recently, this time in the Cincinatti Enquirer, apparently recent medical research is providing some advances into the fairly unexplored territory of why some people get PTSD and others exposed to the same triggers or circumstances do not.

Lawson Wilson, M.D., a professor of psychiatry and family medicine at the University of Cincinnatti, cites research done at Massachusetts General Hospital which has isolate a specific area of the brain, the anterior cingulate, which can become unable to manage the stresses the brain has experienced.

In perhaps the shortest article on record, Wilson states, "Of all the U.S. soldiers and all the Iraqi citizens exposed to combat and terror, roughly one in 10 will end up with post-traumatic stress disorder, or PTSD.  The amazing good news is that the other nine of 10 war survivors will not develop PTSD."

Wilson goes on to say that for the other 10 percent "who are not so lucky or not so resilient, PTSD is like having wild horses locked in the barn.  For long stretches, sometimes years, life might go on without trouble. The horses are quiet. The natural coping instincts work well enough. Then, for mysterious reasons, the demands of life wear down the coping instincts, and anxiety breaks through in the form of nightmares, flashbacks and panic attacks.  They can be as overwhelming as the original trauma, and they don't go away."

Treatment helps, Wilson promises, but isn't specific as to what treatments help.  He does, however, mention the work of Scott Rauch, a neuroscientist at Massachusetts General Hospital, who he asays "has identified a set of brain circuits that are out of whack in PTSD."

It will be interesting to keep our eyes open for more research on this topic and perhaps alerts as to what Rauch is finding at Mass. General as that develops.

Acupuncture and Healing Trauma

The University of New Mexico is studying acupuncture and Post-Traumatic Stress Disorder (PTSD).  An article on the ongoing study is linked here.

An excerpt from the article follows:

Researchers at the University of New Mexico are continuing work on a $250,000 two-year study of the effects of acupuncture in treating PTSD. The study, which began in May, was made possible with a grant from the National Institutes of Health. If successful, it could lay the path for larger trials that incorporate Eastern and Western approaches to treating the condition.

"This is the first study I'm aware of to look at acupuncture as a modality for PTSD," said Dr. Michael Hollifield, an associate professor of psychiatry and family medicine at the university's department of psychiatry and the study's principal investigator. "To date, our research supports using acupuncture for treating PTSD symptoms, including insomnia, anxiety and depression, in addition to some pain disorders. It may do so by stimulating the body's internal opiate system, though much more research on this issue is needed."

Aiding Dr. Hollifield in his research are Nityamo Sinclair-Lian, DOM, and Teddy Warner, Ph.D., who will serve as co-investigators. Drs. Hollifield and Sinclair-Lian collaborated previously on a study on the effects of trauma in Vietnamese and Kurdish refugees. Dr. Sinclair-Lian also runs a public health pain clinic for Vietnamese refugees, and provides acupuncture detoxification for substance users at a local outreach shelter for the homeless.

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Anecdotally, as they say in the medical biz, acupuncture and other traditional healing modalities, are known to offer comfort and relief to numerous health conditions.  We'll list individual acupuncturists here on this blog as we come to learn about ones who are interested in the topic; and in general, check out a comprehensive directory of specialized acupuncturists here, of a type that treats conditions affecting the body, mind and spirit.