Post-traumatic stress disorder (PTSD) is most often associated with veterans of war, but its debilitating effects, which include depression, anxiety, sleep disturbances and even an inability to perform basic life tasks, can affect anyone who has suffered even a single traumatic event. Estimates vary, but nearly 8 million Americans may suffer PTSD each year, as well as between 11 and 30 percent of veterans. Treatments for the most chronic of these cases have remained limited to medications and therapy, none of which promise a cure.
Now, however, researchers at UCLA are using a noninvasive form of treatment called external trigeminal nerve stimulation (eTNS), a form of neuromodulation (electrical stimulation of the nerves) that can be added to an existing regimen of therapy and medication. One of the researchers, Ian Cook, co-developed the still-experimental technique as a treatment for controlling epileptic seizures that were not responsive to medication. In the current study, 12 chronic sufferers of PTSD, whose traumas ran the gamut from car accidents to rape to combat, participated in the eight-week open outpatient study using eTNS. The results were published in the journal Neuromodulation.
“PTSD is a huge, unmet public health need,” Andrew Leuchter, the study’s senior author and a UCLA professor of psychiatry, tells mental_floss.
The study participants received electrical stimulation via a patch on their foreheads connected to a battery-operated device about the size of a pack of cards. They were hooked up to the device for eight hours of mild current stimulation while they slept with “virtually no side effects other than some mild irritation from the patch on the skin,” Leuchter says. The device can be administered at any time of day, but researchers wanted the longest stretch of uninterrupted time possible, so they tested it during sleep.
Ron Ramirez wears the eTNS device, which harnesses current from a 9-volt battery to power a patch that sends a low-level current to cranial nerves that run through the forehead. Image credit: Reed Hutchinson/UCLA
“The trigeminal nerve is the largest of the cranial nerves and feeds directly into the brain. Because it’s a large nerve, we’re able to stimulate it through the skin directly with electrical current,” says Leuchter. The researchers' theory is that the treatment “resets the networks in the brain and restores an individual’s normal ability to regulate their mood.” In particular, they believe it has an effect on a “regulating center” of the brain called the locus coeruleus, which is highly involved in arousal (how awake and alert a person is) and controls the autonomic nervous system, including blood pressure, heart function, and respiration.
“Overall, we saw about 30 percent reduction in symptoms across the board in anxiety, sleep, startle reflex, and all major symptom domains of PTSD,” says Leuchter. They also saw a 50 percent decline in severity of depression. While that may not seem like a particularly strong symptom reduction, Leuchter adds, “Any reduction in symptoms in this population is very important because this was a group that had suffered with treatment-resistant symptoms for a very long time.” One quarter of the subjects’ PTSD went into remission.
While they don’t yet know how long the benefits of the eTNS treatment will last, the preliminary data is encouraging. “The benefits in the small numbers of patients who receive this treatment seem to last well beyond the end of treatment, up to weeks or even months,” he says.
Not only do they hope to continue to offer long-suffering PTSD patients some immediate relief, but to study eTNS's role in treating trauma at its onset. A question that will drive future research, says Leuchter, is: “If you were to take people exposed to a traumatic event and applied this treatment before they have PTSD, can you help them avoid it?”
Since the UCLA study was an augmentation trial—that is, eTNS was administered in addition to patients’ existing regimens of psychotherapy and medication—their next phase of research will be a double-blind study, conducted with the VA in Los Angeles, on veterans who have served in the military since 9/11. Since it will be using placebo treatment, at the end of the study, veterans who received placebo will be given a chance to try the eTNS system, as well.