Exploring treatment options for PTSD and the challenges faced by those who suffer
For people like my father, who has struggled with post-traumatic stress disorder (PTSD) since his time serving in the Vietnam War, an expanding menu of treatment options offers newfound hope.
Trauma-focused therapies like Prolonged Exposure are currently considered the gold standard and first-lines of treatment. These types of treatment can offer benefits to the more than 15 million adults in the U.S. who will suffer from PTSD during their lifetime — and that doesn’t include the families of sufferers, who face their own difficulties. But getting people to stick with therapy can be challenging. Trauma-focused therapies require the individual to work through their thoughts and feelings about the trauma itself - and that can be extremely painful.
Some medications, such as Zoloft and Prozac, can be used to treat PTSD and its symptoms, but research shows they are less effective than psychotherapy and can include a host of unpleasant side effects.
In my research, I have been fortunate to speak directly with Service members who have struggled with PTSD, as well as their families and providers. Many who are suffering from the disorder have tried multiple interventions, including prescribed medication and psychotherapy. Some have resorted to self-medication with alcohol, cannabis, illicit substances, or by misusing prescription drugs. For many, these methods have proven to be insufficient- either due to side effects or delayed reduction of symptoms.
Emerging PTSD treatment options: psychedelics, SGB, and the quest for relief
Enter new, emerging treatment options with preliminary results that have sparked much debate and intrigue.
These new, often illicit, options include psychedelics, such as Methylenedioxymethamphetamine (MDMA), psilocybin and ibogaine. Then, in addition to psychedelic-assisted therapy for ptsd, is a procedure called stellate ganglion block or SGB. Its supporting evidence is strong and compelling- SGB has been shown to be safe, effective and fast-acting: three criteria for an ideal PTSD treatment that have proven elusive.
SGB involves injecting a local anesthetic into the stellate ganglion, a group of nerve cells and nerve fibers in the neck that helps regulate the body’s “fight-or-flight” mechanism. It was found to be effective in treating PTSD in 2020 after our team’s randomized, controlled trial, but the procedure is not really new. It has been used for nearly a century to treat certain chronic pain conditions.
The injection takes about five minutes to administer and then patients are typically asked to stay for 20 to 30 minutes afterward for observation. Side effects are minor and relief appears to be long-lasting in many, but researchers are still trying to determine the ideal frequency of injections and the exact mechanism that makes it effective.
For many who have tried other treatments that didn’t work, SGB has been a life-saver—literally. In speaking with Service members about their experiences with SGB, a number have said they would no longer be alive were it not for SGB and their behavioral health providers. I have witnessed Service members getting teary eyed immediately following the procedure because they felt like a weight had been lifted from their chests. These and other testimonials are powerful.
Unfortunately, the proliferation of novel treatments has also introduced new risks for people who seek relief from their symptoms.
In the case of SGB, while the treatment is becoming more accessible with providers now located across the country, some may be underqualified, and the treatment can range in cost between $600 and $8,000.
Ultrasound guidance is currently accepted as the gold standard for physicians providing SGB. In the past, fluoroscopy was more common, but it comes with slightly more risk and the structures surrounding the stellate ganglion are easier to see with ultrasound. People interested in finding a qualified provider should make sure the doctor uses ultrasound, and they should also ask how many SGBs the physician has performed, as well as the nature of any immediate or delayed adverse effects their treatments may have resulted in. Finally, there are websites that patients can use to rate their experiences with doctors. When looking for a reputable provider, these can be a useful tool in ensuring that others have had a positive experience.
Similarly, as psychedelics continue to be a point of curiosity, unqualified providers, and perhaps even lay people, may start to make claims about some of these compounds that are not yet backed by evidence. Although they are starting to show great promise, these drugs are still experimental — exploring them without proper medical supervision is ill-advised.
Continued PTSD research is essential to uncover new interventions that may assist individuals who are affected on their recovery journey. While we are undoubtedly entering an exciting new era for PTSD treatment with new options available, more research is needed to determine which modalities may be most beneficial and effective in the long term. Treating the aftereffects of trauma can be a time-intensive and daunting task. Be sure to consult with credible health professionals to explore the best treatment options for you. It will be time well spent.
Kristine Rae Olmsted is a research epidemiologist at the nonprofit research institute RTI International. She led a landmark study published in 2020 that found SGB is an effective treatment for PTSD in Service members and is currently leading multiple additional studies regarding SGB.