STELLATE GANGLION BLOCK for PTSD
Although the VAH has not yet approved it, the FDA has just given a waver to Dr. Lipov, an anesthesiologist at Chicago Medical Innovations, to use this approach in treating PTSD. The cost of $1000 can be covered by his 501 not-for-profit corporation. Doctors at Walter Reed Hospital and Naval Medical Center San Diego are also pursuing this new treatment, which can provide immediate relief and allow active duty soldiers who develop PTSD symptoms to return quickly to their posts.
Stellate ganglion blocks have been used for years to treat chronic pain caused by an overactive sympathetic nervous system. Since an overactive sympathetic nervous system can also lead to PTSD, it made sense to try the same treatment. The Stellate Ganglion is a group of nerve cells deep inside the neck near the 7th vertebrae. It’s the top ganglion in a chain that extends along the spinal cord and controls the sympathetic nervous system. Recent research suggests that the Stellate Ganglion also has connections into the brain, especially to the hypothalamus, which controls the hypothalamus-to pituitary gland-to adrenal gland (HPA) axis. Blocking this connection may block the production of stress chemicals, which are thought responsible for PTSD.
The procedure requires an anesthesiologist trained to do nerve blocks in the neck. A needle is guided by fluorescent technology to a spot near the 6th vertebrae where a local anesthetic is released. A temporary drooping of the same side eyelid often accompanies a successful block. Misplacement of the needle can result in side effects including seizure and difficulty breathing. These occur in 1.7 out of 1,000 blocks and return to normal over time.
Case studies are promising and show marked improvement (at least a 50% decrease in symptoms) in 70-75% of clients with PTSD, including those unresponsive to the usual medication and therapy approaches. Most show an almost immediate response with improved sleep, fewer nightmares, and reduced anxiety. Some clients will require a second injection. Individual response varies from mild to complete, but even clients with long-standing PTSD and substance abuse have experienced significant improvement.
TRANSCRANIAL MAGNETIC STIMULATION for PTSD
TMS is already FDA approved for the treatment of depression and autism. Current research suggests it also works for PTSD. Controlled studies show improvement in core PTSD symptoms when TMS is applied over the right frontal area of the brain, specifically over the right medial lateral prefrontal cortex (MLPFC). This coincides with findings in brains of PTSD sufferers, which show abnormal functioning in the MLPFC .
Psychological testing following a series of 10 TMS treatments showed significant improvement in the PTSD symptoms of arousal, re-experiencing, avoidance, and anxiety. To treat depression, the treatments must be focused over the left MLPFC.
How does it work? Magnetic stimulation induces an electrical current in the brain and may work much like ECT by releasing and rebalancing the brain’s chemistry. But TMS does not cause a convulsion, which eliminates the need to take any medication. In fact TMS has few side effects, headache being the most common. No sedation is required and the client can sit in a comfortable chair throughout the treatment.
The research above used 10 sessions. To treat major depression up to 40 sessions may be needed. The cost of the recommended 10 once/daily treatments could run from $5,000 to $10,000, but since successful controlled studies have already been published, this procedure may soon become FDA approved and hopefully covered by insurance.
HYPERBARIC OXYGEN THERAPY FOR TBI and PTSD
The use of HBOT in TBI with and without PTSD has created a heated controversy. On the Pro side, recent scientific studies done by Dr. Harch, and successfully repeated by Israeli scientists, show significant improvement in post-concussive symptoms following mild TBI. Both studies measured cognitive abilities, emotional lability, executive function, and quality of life. SPECT scans of the brains before and after treatment also showed a significant positive change. In addition, PTSD symptoms improve. This makes sense, since MRIs on folks with PTSD also show damage to the brain.
On the Con side of the argument, a study using room air (20% oxygen) at 1.3 bars (1 bar is normal air pressure) as a control group discovered that those patients improved as much as treatment group using 100% oxygen at 2 bars. The authors concluded that all the improvements seen in both their control and treatment groups were due to a placebo effect. The Israeli authors of the article above, argued that room air at 1.3 bars increased available oxygen in the brain by 50% and therefore worked as an active treatment. That would certainly explain why both groups improved.
Less scientific but still significant, some clients treated with HBOT have made remarkable recoveries, even achieving complete remission of both TBI and PTSD symptoms. The cost of HBOT is decreasing as more entrepreneurs open clinics, some offering the standard 40 treatment package for as little as $3000. In hospitals, a single treatment can cost $1800, and insurance won’t pick up the bill.
The treatment itself requires time, usually delivered as one 50-90 minute session per day and requires 40 sessions. During the treatment, you lie on a bed in a pressurized container. There can be complications at the higher pressures (4-6 bars), but the lower pressures used for these studies are usually benign.
Although not officially FDA approved, all three of these treatments have shown good response and have very few side effects. If you’re suffering from severe PTSD and haven’t responded to medication and therapy, what have you really got to lose?