Despite two decades of research and billions spent on care for post-9/11 veterans, treatment-resistant PTSD remains one of the most persistent injuries of the War on Terror. A growing number of researchers are exploring alternatives to conventional psychotropic medications and talk therapy, including neuromodulation-based interventions. Recently, researchers revealed promising results for a new method modeled after a treatment for depression and OCD called Transcranial Magnetic Stimulation (TMS).
For over a century, PTSD among service members has been misunderstood, misdiagnosed, and mistreated. During the American Civil War, doctors observed an epidemic of what they dubbed “soldier’s heart” or “irritable heart”. The symptoms, including heart palpitations and difficulty breathing were attributed to overexertion or knapsack straps being too tight across one’s chest. Many exhibited symptoms now understood as trauma-related psychological distress, including mood instability and agitation.
PTSD became an even larger mental health crisis during the First World War when it was dubbed “shell shock”. The term first appeared in 1915 in the medical journal, The Lancet, describing soldiers who experienced impaired sight and hearing, severe anxiety, nightmares, and tremor after being in close range of exploding shells. However, as the Great War raged on, these symptoms also appeared in soldiers who were nowhere near exploding shells. The understanding changed to a belief that these men were suffering from a neurological degeneration, shifting the diagnosis to “war neuroses”. Soldiers suffering from war neuroses often returned to the field after only several days of rest. Longer term treatments included hydrotherapy and electrotherapy.
In World War Ⅱ, the diagnoses changed to Combat Stress Reaction (CSR) or “battle fatigue”. Combat Stress Reaction accounted for a significant portion of wartime psychiatric casualties and medical discharges during World War II. However, some leaders, including Patton himself did not believe in the disease and instead viewed it as a moral failure.
During the Vietnam War soldiers with intrusive combat-related thoughts, nightmares, hypervigilance, numbness, rage, alienation, and substance abuse issues were diagnosed with “Post-Vietnam Syndrome”. At the time, clinicians attributed symptoms to grief rather than a formal psychiatric disorder. Veterans rallied together to help each other. Some formed informal support groups dubbed “street corner psychiatry”. Others lobbied before Congress and the American Psychiatric Association (APA).
Just five years after the Vietnam War ended, the APA listed PTSD as a diagnosis. Both PTSD and traumatic brain injuries (TBI) are the signature injuries of Iraq and Afghanistan. TBIs add another complex level to treatment of PTSD. It is considered a major public health issue with up to 15.7% of OIF/OEF deployed veterans screening positive. Current treatment includes talk therapy, medication, and other therapies.
However, more than four times as many post-9/11 veterans and service members have died by suicide than were killed in combat operations, leading both veterans and advocates to demand better treatment. Overmedication, VA bureaucracy, and lack of research into alternative treatments have all been called into question. This has prompted more research into PTSD, especially of the treatment-resistant variety.
University of Texas Health in San Antonio may have discovered a breakthrough treatment. TMS is a non-invasive treatment that utilizes electromagnetic nerve pulses to stimulate nerve cells in the brain. It is FDA-approved to treat Major Depressive Disorder and Obsessive-Compulsive Disorder that has not responded to medication. An MRI-guided, robot-assisted version of TMS showed promising results in treating veterans enrolled in the UT study.
In a 30-day study at an inpatient center, researchers used an MRI-guided robot-assisted version of TMS on those enrolled in the study who received the active treatment rather than the placebo condition. Of the 119 participants, 92% were classified as having severe or extremely severe PTSD. Participants were randomized to receive either active MRI-guided TMS paired with psychotherapy or a placebo condition.
One month after treatment, 85% of the active-TMS group showed significant reductions in symptoms. At three-month follow-up, 73% maintained clinically meaningful improvement.
Dr. Alan Peterson, professor of psychiatry and behavioral health at the University of Texas Health Science Center and director of the Consortium to Alleviate PTSD, said: “As we continue to strive for additional ways to improve PTSD care and help more people recover, these study findings give us another valuable tool in the clinician’s toolbox.”
Researchers caution that the results are preliminary and require larger-scale trials before widespread clinical adoption.
If validated in larger trials, the findings could expand non-pharmacological treatment options for service members and veterans with treatment-resistant PTSD, a population that continues to present significant challenges within military and VA care systems.
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About the Author: Jillian Butler is a journalist with a focus on military and veterans, geopolitics, and corruption. She holds a bachelor’s in English and History from the University of Ulster in Northern Ireland and a master’s in International Relations with a focus in Security Studies from the University of San Diego. Before committing to a life of journalism, she worked in both academic research and private sector intelligence focusing on Middle Eastern security and the trafficking of drugs, arms, and humans. In a past life, she worked as a surf instructor in Northern Ireland, teaching both Catholic and Protestant children as part of a community bridge building initiative.