Innovations In Treatment: A PTSD Psychiatrist’s Perspective

​In the ever-evolving landscape of mental health care, the treatment of Post-Traumatic Stress Disorder (PTSD) stands out as a field ripe with innovation and transformative practices. As a PTSD psychiatrist, navigating through the complexities of trauma's impact on the human psyche requires not just an understanding of traditional therapeutic approaches but an openness to the integration of cutting-edge technologies and methodologies. Let’s take a look at this disorder as some of the latest treatment options.

​What Is PTSD?

​PTSD is a disorder that develops after a person has experienced either one traumatic event or multiple traumas. While we often think about soldiers developing PTSD after returning from war, this is just one example of the type of trauma that can lead to PTSD.
 
For instance, a traumatic car accident can trigger this disorder, or perhaps years of abuse from a spouse or parent. Seeing a person die or watching your house burn down or experiencing the horrors of a terrible disease can trigger PTSD. These are just a few of the many examples of traumatic events that could cause PTSD symptoms.
 
According to the DSM-5, a publication by the American Psychiatric Association, symptoms that arise following exposure to traumatic events and fit the criteria for diagnosing PTSD include:

1. Intrusion Symptoms

People with PTSD often face continuous, unwanted, and deeply distressing memories of their trauma. They might have nightmares about what happened, feel like they're reliving the trauma through flashbacks, or experience intense distress from things that remind them of the event. This can include both physical and emotional reactions to anything that brings back memories of the trauma.

​2. Avoidance

People often try to avoid anything that reminds them of a traumatic event they've experienced. This includes steering clear of certain thoughts, feelings, or conversations that bring back memories of the trauma, as well as places, people, or activities that might trigger those painful memories.

​3. Mood Changes

After experiencing a traumatic event, a person's thoughts and feelings might change negatively. These changes could include having trouble remembering parts of the trauma, forming negative views about oneself, others, or the world, or mistakenly blaming oneself or others for what happened. This might lead to feeling sad often, losing interest in activities that were once enjoyed, feeling disconnected from people, and finding it hard to experience joy.

4. Changes In Reactions & Alertness

​People may experience significant changes in their alertness and reactions related to the trauma, which may get worse after the event. This can lead to getting easily irritated or having sudden outbursts of anger, engaging in risky or harmful behaviors, being overly watchful or on guard, jumping at small surprises, facing trouble with focusing and having difficulties with sleep.

​5. Duration of Symptoms

Your symptoms need to persist for more than a month for it to be considered PTSD. As a psychiatrist for PTSD, I find that many of my patients wait for years before seeking treatment, which is a shame, because treatments can be highly effective and reduce or eliminate your symptoms.

​6. Impact on Daily Life

The problems one faces because of these symptoms can seriously disrupt one’s daily life, affecting relationships, work, or other important areas.

​7. Other Causes

​Additionally, it is important to determine that your PTSD is not caused by the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. As a PTSD psychiatrist, I view patients both from a physical as well as mental health perspective and will look at potential physical conditions or other causes that could contribute to any mental health disorder.
 
Keep in mind, that the aforementioned information comes from the DSM-5, but if you’ve experienced any type of trauma and find yourself suffering from anxiety, depression, nervousness, paranoia, difficulty concentrating, nightmares or sleep issues, memory issues, panic attacks or perhaps you turn to substances to help reduce these feelings, seeking treatment can help. 

​Traditional Treatments For PTSD

Traditionally, a PTSD psychiatrist would recommend a combination treatment that includes both talk therapy and perhaps some type of medication. Talk therapy options might include cognitive behavioral therapy, prolonged exposure therapy or cognitive processing therapy.
 
The medications we often use can help reduce the symptoms of PTSD, but they don’t treat the underlying cause of PTSD, which is why talk therapy is so crucial for patients with PTSD. Medications we can use include antidepressants and perhaps mood stabilizers or anti-psychotic drugs. 

​Innovations In Treatment

For many people, the traditional approach works well, but we do have many newer treatment options that have yielded promising results and as a psychiatrist for PTSD, I sometimes recommend some not-so-traditional options for my patients. These might include the following treatments. 

​Eye Movement Desensitization and Reprocessing (EMDR)

​This therapy was developed to help people recover from trauma, including PTSD. With EMDR, we have the patient focus on a traumatic memory while simultaneously using bilateral stimulation (typically through eye movements), which is believed to help the brain process and integrate traumatic memories.
 
EMDR was developed by Francine Shapiro in 19871 and it has been used as treatment for PTSD since the late 1980s. Since its inception, EMDR has become an accepted treatment for PTSD because it so often effectively reduces symptoms as well as the anguish tied to traumatic memories. EMDR also may be helpful for those with anxiety disorders and treatment-resistant depression.
 
In many cases, a person with PTSD also may be suffering from depression, anxiety or other co-occurring disorders and EMDR can be an excellent approach to consider. An anxiety psychiatrist or depression psychiatrist also might recommend this option. Of course, it is important to note that many psychiatrists, such as myself, specialize in treating a wide range of mental health disorders. 

​Ketamine Therapy

Ketamine has been used for treatment-resistant depression with much success, but there is research to show that ketamine also can treat PTSD and greatly reduce the symptoms of this disorder.
 
Ketamine can be a very dangerous drug, so this must be administered in a doctor’s office by trained professionals. As a PTSD psychiatrist, I do still recommend that if you opt for a ketamine treatment you also combine this approach with talk therapy for the best possible outcome. 

​Psilocybin

​Psilocybin, otherwise known as magic mushrooms, is a controversial topic. Of course, psilocybin is only legal in Oregon and Colorado, although it has been decriminalized in cities such as Santa Cruz, CA and Oakland, CA.
 
Psilocybin often is used recreationally, but there is evidence to suggest that this substance can be used to treat PTSD, anxiety and depression. If you do consider this approach, I recommend going to a licensed and legal facility as self-medication is not recommended. I am, however, hopeful that more studies with psilocybin will be conducted because I believe this substance is promising for the treatment of PTSD and other disorders. If you have bipolar disorder as a co-occurring disorder, however, I do not recommend this treatment approach. 

​Stellate Ganglion Block (SGB)

This is a unique approach and one that is not currently FDA-approved for PTSD treatment. However, there is some evidence to suggest that SGB can be beneficial for some PTSD patients, especially for those who have tried other therapies without good results. This treatment is FDA-approved for other conditions, such as complex regional pain syndrome.
 
For this treatment, we inject a type of anesthetic into the stellate ganglion nerves, which are located in your neck. These nerves are an important component of our nervous system, controlling blood pressure and heart rate, among others. Injecting an anesthetic has been shown to reduce norepinephrine levels, which, in turn, may reduce PTSD symptoms.
 
Again, this is an alternative treatment and might only be recommended after you’ve tried other treatment options and found these to be ineffective. Also, it is crucial that if you do opt for this treatment you go to a licensed facility that uses ultrasound to help guide the injection into the correct area.

​Transcranial Magnetic Stimulation (TMS)

For TMS, we use magnetic fields to stimulate the nerve cells in your brain, and you can kind of think of this treatment as a brain “reboot” so to speak. Electromagnetic coils are placed on your scalp and these coils deliver a pulse to stimulate the nerve cells in the region of the brain that handles mood control. TMS has been used successfully for treatment-resistant depression, and some also find that it alleviates PTSD symptoms. ​

​Don’t Wait – Get Help For PTSD Now

​PTSD is a complex mental health disorder that can greatly impact your day-to-day life, but, the good news is that we do have many treatment options to consider and many patients recover from PTSD and enjoy a much happier life.
 
As a psychiatrist for PTSD, I urge you to seek treatment as soon as possible. No one should have to suffer from past traumas, and I will work diligently to find a treatment plan that addresses your PTSD as well as any other mental health disorders you face.
 
Whether you need a psychiatrist for PTSD or perhaps a psychiatrist for anxiety, a psychiatrist for depression, bipolar disorder, eating disorders, substance use disorders or other mental health conditions, I provide services at my office in Thousand Oaks as well as telepsychiatry. Contact me at any time to set up a thorough evaluation and let’s get you started on a path toward a better life.