A Potential Therapy for PTSD?

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The latest edition of the medical journal Psychiatric Annals features military researchers discussing how a procedure known as stellate ganglion block can effectively treat post-traumatic stress disorder (or PTSD).

Injecting a local anesthetic agent into the sympathetic nerve tissue at the base of the neck — a so-called stellate ganglion block (or SGB) – acts to numb signals which travel to centers deep in the brainstem and brain, commonly thought to be most responsible for PTSD.

The prospect of using a medical procedure to treat PTSD would be a paradigm shift for psychiatry.

That PTSD can be thought of an injury – something whose symptoms could be alleviated by injecting numbing medicine – would support the assertion that former Vice Army Chief of Staff General Peter Chiarelli has been advocating for some time that PTSD should be renamed PTSI – with an I for injury.

“It might seem counterintuitive that treating the peripheral nervous system could affect psychiatric conditions presumably mediated in the brain,” writes Dr. Cam Ritchie, my colleague and retired Army psychiatrist, in a press release for the journal heralding the news.

Unlike Dr. Ritchie, I am not so surprised by these findings.

My research focuses on the harmful effects of a class of drugs called quinolines, most notably the antimalarial drug mefloquine (or Lariam), which has been widely prescribed to deployed troops in Somalia, Iraq, and Afghanistan at high risk of PTSD. Many of the unpleasant symptoms caused by mefloquine, including anxiety, panic attacks, nightmares, and sleep problems, can often be difficult to distinguish from those attributed to PTSD.

Mefloquine also adversely affects centers in the brainstem and brain, where it may have neurotoxic effects, and may cause balance and vision problems and many symptoms that resemble those seen with traumatic brain injury (TBI). Indeed, in 2012, the Centers for Disease Control wrote that the mental and neurological side effects of the drug can “confound the diagnosis and management” of PTSD and TBI.

Quinine, a naturally occurring quinoline, and the earliest antimalarial drug, displayed a similar propensity to many of these effects, causing a syndrome known as cinchonism. What I find interesting is that scientific papers from more than 50 years ago describe using SGB to treat symptoms of quinine toxicity.

The latest findings are certain to raise many questions.

But it is becoming increasingly clear that PTSD – or PTSI – may be more than just a simple mental disorder. The effects of PTSD, TBI, and now mefloquine toxicity, need to be considered together – as the three signature injuries of modern war.

Dr. Remington Nevin is a former Army preventive medicine physician and epidemiologist, now pursuing doctoral studies in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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