🎗️PTSD Without Medication: FDA-Approved New Treatment Uses The Patient's Own Brain To Guide Therapy
Updated: Sep 9
What if trauma treatment could be tailored to each person's brain? A new technology combines brain activity analysis with personalized magnetic stimulation. According to preliminary results, the method reduced symptoms of post-traumatic stress disorder (PTSD) by 52% and led to remission in 68% of participants.
PTSD can arise after experiences such as war, accidents, disasters, or violence. Nightmares, intrusive memories, anxiety, and a constant state of alertness can persist for years.
Current treatments include psychotherapy and medication, but not all patients respond well. Now, the US regulatory agency has authorized a new drug-free option based on each person's brain activity.
The technology begins with an examination that records the brain's electrical activity through sensors placed on the head. This information shows patterns of brain function that may be related to the disorder.
A computer system analyzes this data and helps define how the treatment should be carried out. Then, a coil positioned on the scalp sends magnetic pulses to the brain. These pulses produce small electrical currents capable of modifying the activity of groups of neurons.
The difference lies precisely in the personalization. In traditional magnetic stimulation, many people receive very similar protocols. In this new system, the treatment parameters are adjusted according to the brain activity pattern of each patient.
The idea is that, just as different people may need different medications or doses, different brains may also respond better to different forms of stimulation.
To test the technology, people with post-traumatic stress disorder received five sessions per week for five to six weeks. The researchers assessed the intensity of symptoms before and after treatment and also checked whether the effects remained after the end of the sessions.
STEP 1: EEG Recording. Researchers perform a 10-minute quantitative electroencephalogram (qEEG) with eyes closed and an electrocardiogram (ECG) that measures brain wave frequencies, as well as heart rate and brain-heart coherence.
STEP 2: Braincare™ Analysis and Protocol Generation. The brainwave recording is sent to the Wave Neuroscience cloud platform, where it is processed and compared to a database of over 60,000 brainwave recordings. Your digital brain image is converted into an easy-to-interpret report, complete with detailed information and comparisons by age and sex. If we identify areas of the brain that are not functioning correctly, partners can use this report to generate a patient-specific care protocol and track progress over time.
STEP 3: Personalized TMS Therapy. If the report indicates that you could benefit from personalized brain stimulation, a protocol is generated based on brainwave recording data and can be administered through in-clinic therapy called MeRT. Brain stimulation sessions occur daily, 5 days a week, for approximately 30 minutes over a month. During this period, your personalized protocol is used to intelligently choreograph brainwave activity, bringing it to a more synchronized state.
According to preliminary results released by the company responsible for the technology, symptoms decreased by approximately 52%, and approximately 68% of participants achieved remission, meaning they no longer presented symptoms at a level consistent with the disorder.
The results are especially relevant because a portion of patients do not improve sufficiently with available treatments. These numbers have drawn attention because currently available treatments do not work for everyone. A previous review of medications for the disorder found relatively modest improvements in many patients, and only a small percentage achieved remission.
Furthermore, some people abandon psychotherapy because repeatedly talking about traumatic experiences can cause a lot of anxiety. A treatment that doesn't rely on medication and doesn't require the patient to verbally relive the trauma could therefore represent an important alternative. Still, the results published so far should be interpreted with caution and need to be confirmed by further research.
The proposal goes beyond post-traumatic stress disorder. Researchers believe that, in the future, the same combination of brain analysis and personalized stimulation could be studied for other conditions, such as depression and anxiety.
The concept is simple, but it represents an important shift: instead of offering exactly the same treatment to everyone, using each patient's brain as a guide to decide how therapy should be applied.
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WAVE NEUROSCIENCE
Comparing Medications for DSM-5 PTSD in Routine VA Practice
Brian Shiner, Christine E Leonard, Jiang Gui, Sarah L Cornelius, Paula P Schnurr, Jessica E Hoyt, Yinong Young-Xu, and Bradley V Watts
J Clin Psychiatry. 2020 Oct 13;81(6):20m13244.Â
doi: 10.4088/JCP.20m13244.
Abstract:
Objective:Â Fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine have previously shown efficacy for posttraumatic stress disorder (PTSD). One prior study using US Department of Veterans Affairs (VA) medical records data to compare these agents found no differences in symptom reduction in clinical practice. The current study addresses several weaknesses in that study, including limited standardization of treatment duration, inability to account for prior treatment receipt, use of an outdated symptomatic assessment for PTSD, and lack of functional outcome.
Methods:Â A total of 834 VA outpatients were identified with DSM-5 clinical diagnoses of PTSD between October 2016 and March 2018 who initiated one of the medications and met prespecified criteria for treatment duration and dose, combined with baseline and endpoint DSM-5 PTSD Checklist (PCL-5) measurements. Twelve-week acute-phase changes in PCL-5 score and remission of PTSD symptoms were compared among patients receiving the different medications, as was use of acute psychiatric services in the subsequent 6-month continuation phase.
Results:Â In the acute phase, patients improved by a mean of 6.8-10.1 points on the PCL-5 and 0.0%-10.9% achieved remission of PTSD symptoms. Those taking venlafaxine were significantly more likely to achieve remission (P = .008 vs fluoxetine and P < .0001 vs paroxetine, sertraline, and topiramate). In the continuation phase, there were no differences in acute psychiatric care use between medications. Those who continued their medication were less likely to use acute psychiatric services (HR = 0.55; P = .03).
Conclusions:Â There may be an advantage to venlafaxine over other agents in achieving acute-phase remission for DSM-5 PTSD in routine clinical practice, but this finding requires further study. Regardless of the agent chosen, medication cessation during the continuation phase is associated with a higher risk of acute psychiatric care use.
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