June marks ‘PTSD Awareness Month’ and here at HRW we have a rich history of researching the condition from both the perspective of Healthcare Professionals and patients. In celebration of this awareness month, Abigail Graham (Research Manager and member of our neuroscience expert team, Synapse) took the time to sit down with a member of our Expert Panel (our selection of friendly, thought-leader HCPs) to check in on where we are today and more importantly where the future of treatment lies. She also spoke to a patient who has been recently diagnosed with PTSD after a traumatic birth experience to understand the extent to which these advances will address patient unmet needs. “During my time at HRW I have developed a passion for researching across different neurological conditions, and as a mental health first aider, I have developed a particular interest in a variety of mental health conditions. In recognition of PTSD Awareness Month, I thoroughly enjoyed chatting to both an expert psychiatrist who has been treating patients diagnosed with PTSD since the 1980s, and a patient who has been recently diagnosed with PTSD- to get a real insight into this complex landscape.” Stigma and Patient Experiences From an HCP perspective, the stigma surrounding psychiatric conditions is improving and this includes the stigma that surrounds PTSD. In recent years, there have been vast improvements in treatment which now means HCPs and patients can ‘see’ the results which can make a difference in patient’s lives. HCPs are no longer solely reliant on psychotherapy and psychoanalytical therapy to treat PTSD and are now starting to use pharmacological therapies. This more holistic approach to treatment is more effective which has helped reduce the overall stigma associated with the condition. However, as a mental health first aider, I hear and I know that stigma still surrounds PTSD. Although patients are coming forward quicker and more confidently, this is still a challenge for them. There is also vast miscommunication in wider society about who and what can trigger PTSD – for example, did you know more people are diagnosed with PTSD because of birth complications vs. war each year? Patients can delay coming forward to seek treatment as they can feel guilty about developing PTSD. Patients are often worried about feeling or appearing to be vulnerable and it can take time for them to present to healthcare professionals. The patient I spoke to was ‘ashamed’ of sharing her experiences even to her close family and friends and found discussing her symptoms with her GP challenging. Although the GP was ‘attuned’ with post-natal depression, they were not well equipped to treat and discuss PTSD with her. As a result, this patient self-referred to a psychiatrist and received EMDR therapy (Eye Movement Desensitisation and Reprocessing Therapy). Future Treatment Advances For our expert psychiatrist, the biggest advances in the future will be augmenting pharmacological treatments with psychological therapies (for example CBT). Overall, the future of pharmacological treatments will need to take both a reactive and proactive approach: stopping the imprinting from happening and unlocking pathways in the brain to allow the memories to be processed correctly. Propranolol (A proactive approach) Propranolol is a widely used cheap oral betablocker. The drug stops the traumatic memory from imprinting on the brain and ensures the brain processes the memory. It has been widely used in the US as part of their treatment approach for trauma victims when they present in the emergency room. Our expert psychiatrist has also been using the treatment off-label with his patients: in some cases, flash bulb memories stop overnight. Psychedelics (A reactive approach) Although a potential contentious topic and a ‘buzz word’ in psychiatry, our expert psychiatrist believes psychedelics (specifically MDMA) have a future in the treatment of PTSD. Psychedelics have the potential to ‘unlock’ pathways in the brain and ‘force’ the memories out of hiding. Psychedelics bring memories to the surface and allow psychotherapy to be more effective by allowing the patient to process the memories and stop the flashbacks and nightmares. A patient perspective When thinking about pharmacological treatment, our patient reflects that EMDR therapy was very successful for her. However, it took a while to have a psychological impact, triggered nightmares throughout treatment and was extremely harrowing to undergo (made harder whilst caring for a new born child). A pharmacological treatment could have helped support her during the therapy and would be welcomed, but only if the treatment was well tolerated and (in her case) did not impact on breast feeding. However, it should also be noted that the use of pharmacological treatment to treat PTSD would be very individualised for each patient: for some they wouldn’t want the ‘chemicals’ in their body and would prefer to focus on the psychotherapy route. For others, drug therapy is seen as the ‘next step’ for treatment. Concluding Remarks Overall, this dual-pronged approach has the potential to support patients and provide them with better outcomes: allowing embedded memories to be processed effectively and preventing memories from imprinting. And if we take learnings from the past with the relationship between stigma and effective treatment, we can hypothesise that with these advances, stigma will continue to decrease – addressing a key challenge associated with PTSD. But I still need to ask myself the question – will this approach address the inner ‘fear’ and ‘shame’ of developing symptoms of PTSD from a patient perspective? Will this change in treatment approach be enough to encourage patients to seek support? Or does more still need to be done to break down the walls and address the stigma associated with PTSD? From my perspective, the advances in pharmacological treatments will only go so far to address the patient unmet need. Specifically, more needs to be done to raise awareness about PTSD and to break down societal stigma to help encourage patients to seek support. As without this support, advances in pharmacological treatments can only go so far. By Abigail Graham Apply Now!