Nonconventional interventions for chronic post-traumatic stress disorder (PTSD): Ketamine, repetitive trans-cranial magnetic stimulation (Rtms) and alternative approaches

Alarmingly, only 59% of those who have post-traumatic stress disorder (PTSD) respond to SSRIs. Many of the existing treatments, both pharmacological & non-pharmacological, don't directly target trauma memories which lay at the core in the PTSD pathogenesis. Notable exceptions are medications like ketamine and propranolol and trauma focused psychotherapies like eye movement desensitization and reprocessing therapy (EMDR, developed by Shapiro) and TIMBER (Trauma Interventions using Mindfulness Based Extinction and Reconsolidation for trauma memories, developed by Pradhan). Although anti-depressant effects of ketamine is no longer news, its effects on treatment refractory PTSD (TR-PTSD) is a recent concept. As TR-PTSD has marked public health burden and significant limitations in terms of treatment interventions, a thorough assessment of current strategies is required. Research to bring clarity into the underlying pathophysiology and neurobiology of TR-PTSD delineating the chemical, structural, and circuitry abnormalities will take time. In the interim, in the absence of a "one size fits all" therapeutic approach, pragmatically parallel lines of research can be pursued using the pharmacological and non-pharmacological treatments that have a strong theoretical rationale for efficacy. This article aims at reviewing the current literature on interventions for PTSD, most notably ketamine, transcranial magnetic stimulation (TMS) treatment, yoga and mindfulness interventions, and TIMBER. We present an outline for their future use, alone as well as in combination, with a hope to shed additional insights as well as advocating for developing more effective therapeutic intervention for this treatment resistant and debilitating condition..

Journal

English

Basant Pradhan
Jessica Kluewer D'Amico
Ramkrishna Makani
Tapan Parikh

Pradhan B., D'Amico, J. K., Makani, R., & Parikh, T.. (2015, July). Nonconventional interventions for chronic post-traumatic stress disorder (PTSD): Ketamine, repetitive trans-cranial magnetic stimulation (Rtms) and alternative approaches. Journal of Trauma & Dissociation.  doi:10.1080/15299732.2015.1046101