By Ernie Hood
The recent National VA Research Week (May 16-20) and PTSD Awareness Month in June are ideal times to assess the state of science regarding posttraumatic stress disorder (PTSD), the often-debilitating psychiatric condition that can arise in the wake of intensely stressful life events such as combat, trauma or disaster.
Part of raising awareness about PTSD is publicizing the federal program devoted exclusively to gathering and disseminating scientific information about the illness: the Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder (NCPTSD), is a centers of excellence consortium with seven VA academic centers based on areas of special expertise.
NCPTSD has flourished since it was established in 1989, and continues to help policymakers, the medical and caregiving community, patients, and the general public understand the scientific basis for PTSD, circulating that information globally through a variety of educational and research initiatives.
“Research is helping us better understand how to address PTSD, how to prevent people from developing it, and how to treat it,” said NCPTSD Executive Director Paula Schnurr, Ph.D. “One of the most exciting changes in our field is that we have a range of effective treatments, so people who have PTSD have a choice among types of medications and among types of psychotherapies, and they can really see a life that goes beyond PTSD.”
PTSD now fully acknowledged as a serious mental illness
The field took a major step forward in 1980, when PTSD diagnostic criteria were first formalized and the American Psychiatric Association added the condition to its Diagnostic and Statistical Manual of Mental Disorders (DSM-III at the time, now DSM-V). Since then, research has increased significantly, and clinical thinking has evolved as the knowledge base has grown.
“We used to think of PTSD as a more chronic condition, but given the effectiveness of some of the treatments that we have right now, we no longer believe that people have to cope with their PTSD or learn how to live with their PTSD,” Schnurr said.
Clinical practice has also become more evidence-based in recent years, she noted, as a number of professional organizations have developed guidelines for treating PTSD, including the VA and the Department of Defense, the American Psychiatric Association, the American Psychological Association, and a multidisciplinary professional society called the International Society for Traumatic Stress Studies, among others.
The guidelines—despite the diversity in where they are from and how they were developed—are in broad general agreement and consistency today about how to best treat PTSD.
“The most effective psychotherapies are cognitive behavioral approaches that include techniques like exposure and cognitive restructuring, as well as a treatment called eye movement desensitization and reprocessing, or EMDR,” Schnurr said.
Medications such as antidepressants also play an important role in PTSD treatment, and are recommended in all of the guidelines. Schnurr added that there is considerable research interest in the development of novel medications.
Where PTSD research is headed
Schnurr cited significant research activity in a number of areas. In terms of treatment, she said there is much attention to making the effective treatments already in use even more effective and for more people. Availability is another key issue, as strategies are being developed to make treatment more convenient through in-home therapies using tele-health, self-help apps, and other web-based technologies. Also at the forefront is use of complementary and alternative methods such as meditation and yoga to enhance the effectiveness of other treatments.
“There’s also great interest in more conclusive prediction of who will develop PTSD and who will respond to treatment,” Schnurr said. In many cases, such predictions can be done at a group level to help identify the relative impact of important variables, but not at an individual level, which would be useful for predictive screening.
One area where advances are helping to individualize medicine is combinatorial pharmacogenomic tests like GeneSight® Psychotropic, which analyze how an individual’s genetic makeup affects response to a broad panel of medications prescribed for mental health conditions, including PTSD. These tests can help healthcare providers select the medicine and dosage best suited to a person’s condition and genetic makeup.
“Making the GeneSight Psychotropic test available to VA doctors to help guide patient medication and treatment decisions can make an enormous difference to veterans who need and deserve our help,” Donald R. Wright, Chief Operating Officer of Assurex Health, the maker of GeneSight, said. “We have a real opportunity to help doctors improve the lives of so many who have given so much for all of us.”
Schnurr sees the field as being poised to build upon the last several decades of research to provide new vistas for effective PTSD treatment. “To me, right now we’re at the most hopeful period we’ve had in understanding PTSD, and through research, things are getting better every day.”
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