Hyperbaric Oxygen Therapy (HBOT) has shown promise for veterans with post-traumatic stress disorder (PTSD) by promoting neuroplasticity and improving brain connectivity. In a recent study, veterans treated with HBOT showed significant reductions in PTSD symptoms and depression, with positive changes in connectivity in brain areas associated with emotional processing. These findings suggest that HBOT may be an effective alternative for patients who do not respond well to conventional PTSD treatments.
Post-traumatic stress disorder (PTSD) is a condition that has profound and lasting impacts on the social, emotional, and professional lives of many combat veterans, leading to social integration problems and behavioral difficulties.
Despite advances in psychotherapy and medication, it is still common for many veterans with PTSD to fail to fully overcome the disorder; even after standard treatments, most remain diagnosed.
Studies conducted in Israeli clinics and other countries show that response rates to PTSD treatment are limited, especially among military personnel. In Israel, for example, only 39.4% of treated veterans experienced complete remission of symptoms.
In the United States and Australia, the data are similar, suggesting an urgent need for new treatment approaches for these populations.
Recently, science has been exploring an innovative approach to treating PTSD: Hyperbaric Oxygen Therapy (HBOT). PTSD may be linked to physical changes in the brain, especially in areas that regulate emotional processing.
Neuroimaging studies (functional magnetic resonance imaging or fMRI) show that PTSD is associated with changes in the connections between the prefrontal cortex (responsible for functions such as decision-making and emotional control) and the limbic system (which regulates emotions and responses to stress).
Based on these findings, scientists have begun to investigate methods that promote neuroplasticity, that is, the brain's ability to reorganize itself and form new connections. HBOT is a treatment that involves exposing the body to high concentrations of oxygen in a pressurized chamber, stimulating the process of neuroplasticity and favoring the recovery of damaged areas of the brain.
This process occurs because excess oxygen causes cellular changes that promote the formation of new blood vessels, cell growth, and even neuron renewal. These benefits have already been observed in patients with the after-effects of strokes and traumatic injuries.
The current study aimed to evaluate the effectiveness of HBOT in combat veterans with PTSD who had no history of traumatic brain injury (TBI). Conducted between 2020 and 2023, the study included veterans aged 25 to 60 with severe PTSD.
They were randomly divided into two groups: one group received the real treatment with 100% oxygen at high pressure, and the other group (control) underwent a simulated treatment with oxygen at low pressure. Each received 60 sessions of 90 minutes.
To measure the effects, the researchers used questionnaires and functional magnetic resonance imaging scans before and after the treatment.
The main criterion for success was a reduction of at least 30% in PTSD symptoms. The results showed that the group receiving the real treatment (HBOT) had a significant reduction in symptoms, including a significant drop in PTSD and depression scores.
The figure shows increased functional connectivity between the left lateral prefrontal cortex (c) and bilateral thalami (a), and between the right lateral prefrontal cortex and the supramarginal and angular gyri, putamen, insula, precuneus, and right frontal pole (b). Within the salience network (d), increased connectivity was noted between the bilateral rostral prefrontal cortex and the right frontal pole. There were no significant group-by-time reductions in connectivity.
The hippocampi and amygdala as seeds did not have significant group-by-time interactions based on seed-voxel analysis.
In addition, fMRI scans revealed improved brain connectivity, especially in networks responsible for emotional processing and behavioral control.
In summary, HBOT therapy not only reduced PTSD symptoms in veterans but also strengthened brain connectivity in areas important for emotional control.
These results offer a new perspective on the treatment of PTSD, indicating that HBOT may be a promising approach for those who do not respond to traditional treatments.
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Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder: A Randomized, Sham-Controlled Clinical Trial
Keren Doenyas-Barak, Ilan Kutz, Erez Lang, Amir Assouline, Amir Hadanny, Kristoffer C. Aberg, Gabriela Levi, Ilia Beberashvili, Avi Mayo, and Shai Efrati
J Clin Psychiatry 2024;85(4):24m15464
Abstract:
Cumulative data indicate that new protocols of hyperbaric oxygen therapy (HBOT) may induce neuroplasticity and improve clinical symptoms of patients suffering from posttraumatic stress disorder (PTSD). The current study aimed to evaluate the effects of HBOT on veterans with combat-associated PTSD (CA-PTSD) in a randomized, sham-controlled trial. Male veterans aged 25–60 years with CA-PTSD, with a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score above 20, were included. Exclusion criteria included a history of traumatic brain injury, other psychiatric diseases, or contraindication to HBOT. Participants were randomly assigned to HBOT or sham intervention. Both interventions involved 60 daily sessions, with 90 minutes of either 100% oxygen at 2 atmospheres absolute (ATA) (HBOT) or 21% oxygen at 1.02 ATA (sham) with 5-minute air breaks every 20 minutes. CAPS-5 score, Beck Depression Inventory-II (BDI-II), the Depression, Anxiety and Stress Scale 21 Items (DASS-21), and resting-state functional magnetic resonance imaging (rsfMRI) were assessed at baseline and posttreatment, with the primary endpoint defined as a 30% reduction in CAPS-5 score from baseline. The study was conducted between February 2020 and July 2023. Of 63 veterans who underwent randomization, 56 completed the study protocol (28 in each group). The HBOT group showed a significant decrease in mean CAPS-5 total score, from 42.57 ±9.29 at baseline to 25.8±9.5 following HBOT (P< .001) and 25.08± 13.08 at follow-up (P< .001). The sham group demonstrated a significant increase in CAPS-5 total score from baseline to follow-up, from 45.11 ±8.99 to 47.75± 11.27 following HBOT (P= .069) and 49.22± 10.26 at follow-up (P= .011). Significant improvements in the depression domain of the DASS-21 questionnaire and BDI-II were demonstrated (F=4.55, P= .03 and F=4.2, P= .04, respectively). The stress and anxiety domains of DASS-21 did not reach statistically significant levels. Analysis of rsfMRI demonstrated improved connectivity within the 3 main networks (default-mode network, central-executive network, salience network) in HBOT vs sham groups. Dedicated HBOT protocol can improve PTSD symptoms of veterans with CA-PTSD. The clinical improvement was accompanied by enhanced functional connectivity demonstrated by rsMRI.
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