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.

8 comments
luriajoseph
luriajoseph like.author.displayName 1 Like

Fascinating. BUT let's not forget that PTS is part and parcel of a complex multi-dimensional phenomena: emotional, relational, moral, spiritual, cultural, and, yes, political. If disabling symptoms can be remedied with zero complications, let's do trials. But pts is also the psyche's natural route to healing from overwhelming trauma. We need to find ways that support the psyche's natural healing tendencies.These include creating trusting environments and communities where trauma can be safely represented, re-experienced in a titrated way, and re-encoded. Symtoms gradually abate and post traumatic capacities grow. Life is re-enlivened and enriched. I'm concerned that even IF such injections as described completely remove disabling symtoms, with no complications, which is unproven and highly unlikely, there might still be a price to pay.  I had the same reaction to the idea that a certain medication could potentially eliminate post traumatic memories which plagued survivors' sleep.

When we try to "hot wire" reality there are often unintended effects we cannot envision, not the least of which would be foreclosing the real human encounter with anguish, which can be, if supported skillfully, life changing.

anitahickey
anitahickey

@luriajoseph Think of this injection as a correlate of a trigger point injection (an injection into a muscle band with a reactive "trigger point). The individual with the muscle spasm may have been able to previously relieve the spasm with stretching, massage, relaxation, etc. In this instance, the spasm persists and is limiting function and causing disruption of his/her activities of daily living.  Let's say that the individual is offered a trigger point injection. A hair like needle is inserted into the trigger point(s) of the affected muscle and a small amount of local anesthetic is injected. The local anesthetic effects include: increase of blood flow to the muscle, relaxation of the muscle fibers, an acupuncture like effect, and a "resetting" of the neural signaling from the area as the  nerve signals are blocked for several hours. Although the local anesthetic effects are temporary, the increase in blood flow to the area brings in oxygen and nutrients and has a "washout" effect on byproducts of the prolonged anaerobic state which has existed in this area of the muscle. The local anesthetic resets the transmembrane electrical potential which is essential for the multiple metabolic processes that occur at this interface (see "the Biology of Belief" by Bruce Lipton PhD". The pause in pain fiber neural signaling results in a decrease in the upstream release of a cascade of inflammatory mediators which have been feeding the positive feedback loop or "vicious cycle" which in turn has been maintaining the persistent state of pain and muscle spasm. Even though the local anesthetic only lasts for a few hours, these secondary effects can allow the body to self regulate.  The individual will still have stress. If they deal with it by holding their stress in these muscle groups, they may have recurrent trigger point injections. If they also are taught how to effectively process stressful events and effective relaxation techniques, they will be less likely to have recurrent muscle spasms and persistent trigger points. 

 In regard to PTSD. after any treatment that has a calming or regulating effect on the body's physiologic networks, the patient may still have dreams, but they report responding to the dreams or memories in a less painful or traumatic manner. 


luriajoseph
luriajoseph

@anitahickey @luriajoseph

Were that the psyche, the body-mind, the heart and the soul were simply muscles.

luriajoseph
luriajoseph

@anitahickey @luriajoseph Of course body and mind are connected and so some bodily administered procedures may bring symptomatic relief. But they are not are not a fix, not an RX for PTSD.

anitahickey
anitahickey

@luriajoseph

Also supporting the connection between physical manifestations of PTSD, see the article by Joseph A. Boscarino:

Posttraumatic Stress Disorder and Physical Illness Results from Clinical and Epidemiologic Studies

Ann. N.Y. Acad. Sci. 1032: 141–153 (2004). © 2004 New York Academy of Sciences.

doi: 10.1196/annals.1314.011

anitahickey
anitahickey

@luriajosephIf we look at the human being from the standpoint of quantum biology and consciousness, then yes, mind, body and spirit are connected. Acupuncture has treated PTSD for over 5,000 years by utilizing small needles inserted into the scalp and body to remove blockages between mind body and spirit which prevent healing of the body after an individual has had an experience outside of the realm of normal human experience (see the 7 internal and external dragon's treatment and aggressive energy treatments in 5 element acupuncture). Dr. Michael Moskowitz and Dr. Marla Golden utilize the body to treat the mind and the mind to treat the body utilizing the principles of neuroplasticity. Our current biomedical paradigm sees the body as separate from the mind and even separates treatment of all body parts from treatment of the mind. It does not recognize the spirit or any qualitative factors relating to health and wellbeing but concentrates on the quantitative, objective factors relating to symptoms or disease management. In Germany, neural therapy is taught in medical school. It is the use of local anesthetic to treat pain and normalize the physiology of the body by scar injection (removing interference signals), trigger point injections, injections of local anesthetic into autonomic ganglion such as the Stellate Ganglion. We utilize the mind and body to process our thoughts and emotions and thus, when the body is out of balance physiologically due to large scale and persistent physical or emotional trauma, we may not be able to regulate either our thoughts, emotions, or our physiology. Individuals with PTSD often also have hypertension, problems with digestion and elimination, chronic pain and have been shown to be at higher risk for chronic disease and death than veterans without PTSD. The mind, spirit and body are not separate. Other renown physicians who have written in support of this connectivity are: Dr. Herbert Benson, cardiologist, author of "the Relaxation Response, The Mind/Body Effect  and many other books  (Mass General. Deaconness Hospitals, Boston), Dr. Bernard Lown, Cardiologist and author of "The Lost Art of Healing" (Brigham and Women's hospital in Boston).


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