Treating PTSD – what have we learnt in 160 years?

Like most people, I thought the phenomenon of PTSD was first observed after the First World War, when veterans were diagnosed as something then referred to as “shell shock”. (The term post-traumatic stress disorder wasn’t coined until the 1970s.)

But it turns out, according to an article by Robert Wilbur and Martha Rosenberg, that the first scientific study of PTSD dates back to the American civil war when a medical surgeon noticed that some soldiers couldn’t take to the field because of symptoms such as “palpitations, shortness of breath, chest pain, fatigue and diarrhea” and “sleeplessness, nightmares, fearfulness and difficulty concentrating”.

The authors then go on to give other historical examples of the condition – then known as Da Costa’s syndrome, after the military surgeon who identified it – and some of the treatments.

Some of those treatments were crude, such as the application of electric current or forcing the sufferer to confront their worst fear (e.g putting someone afraid of being alone in a room on their own). Drugs such as morphine and barbiturates were used.

When we come to the modern day, there is still a large amount of trial-and-error going on with PTSD treatments. The authors, who are US-based, refer to the use of antipsychotics and SSRI anti-depressants to treat the condition, though they also acknowledge the use of psychotherapeutic treatments such as cognitive-based therapy (CBT).

In the UK, drug treatments for PTSD are not recommended as a first line of treatment because of the “very limited” evidence base. Instead, CBT and eye movement desensitisation and reprocessing (EMDR) are preferred, though it isn’t necessarily easy to gain access to these treatments on the NHS.

Research into treatment continues. Most of that research, however, is being carried out in the US on veterans, and much of it is small scale. The range of suggestions for what might help veterans with PTSD is wide and includes yoga, running, virtual reality simulations of combat situations, caring for or working with animals (especially dogs or horses) and drugs (there is evidence that marijuana in particular may help with PTSD symptoms).

The difficulty with some of these is that they don’t always transfer well to other sufferers of PTSD, such as women with birth trauma. It’s wonderful that the healing power of animals is being acknowledged, but most new parents have good reasons for not wanting to acquire a dog. Even if marijuana is at some point legalised for medical use, it’s less than ideal for a woman looking after a small baby, especially if she is breastfeeding. Exercise offers many benefits, but finding the time and energy to run when you’re caring for a newborn is never going to be easy.

We know a lot more about PTSD now than Da Costa did 160 years ago. But we still have a long way to go – and if we want to find effective treatments, we need to test them not just on veterans, but other sufferers of PTSD, whether they are victims of violence, survivors of car crashes or new mothers.

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