Treatments for the PTSD Explosion Due to Covid-19
Besides the long-term effects of Covid-19 on the body, there is growing recognition of the psychological impact that Covid-19 has on the community at large, and growing concern for the enduring effects on the psyche.
The numbers lend credence to the concern: 66.4 million people are recovered from Covid; scores of millions who have yet to recover; and the families of the 2.6 million dead.
The psychological impact of previous pandemics suggests what to expect as Covid-19 continues to take a toll on physical and mental health. Findings from Ebola, H1N1 influenza pandemic (2009), severe acute respiratory syndrome (SARS, 2002/2003), and Middle East respiratory syndrome (MERS, 2012) outbreaks show that people were distressed by changes to their daily routine, fear, grief, loss and stigmatization long after the worst was over.
Current research shows that patients who were intubated during hospitalization for Covid-19 had significantly more PTSD symptoms than those who had mild symptoms and were cared for at home.
Eugene Lipov, MD, who specializes in psycho-anesthesia , told Medical Daily that patients who are hospitalized with Covid-19 display PTSD symptoms due to the amount of fear they experience.
When told they have Covid-19, these patients fear they may die as they know that more than 500,000 people in the US have died so far. The fear increases with need for intubation, leading to staring off into space, which Dr. Lipov stated is a sign of PTSD.
Hospitalized patients are not alone in the development of anxiety, depression and PTSD symptoms. Few are untouched by this pandemic; including caregivers, frontline workers in grocery stores and other retail outlets, teachers and healthcare workers. Some of the pandemic related events that people are experiencing include:
- social isolation
- financial loss
- loss of identity related to employment or business closure
- loss of control due to the lack of accurate information related to the spread and treatment
- loss of cultural identity and rituals
- disbelief when health care professionals develop Covid-19
- fatigue due to multiple, unanticipated responsibilities such as parenting distance learners
- caregiver fatigue when caring for a Covid-19 patient at home
- caregiver fatigue when caring for a Covid-19 survivor after discharge from hospital
- survivor’s guilt when family members are sick or have died from Covid-19
- panic as the local case numbers increase and fluctuate
With an expected explosion of Covid patients developing PTSD, healthcare professionals are exploring effective treatments and medications.
Dr. Lipov, who prefers the term Post Traumatic Stress Injury (PTSI) rather than PTSD, has worked with combat veterans to help them recover from PTSI by using a nerve block treatment. His interest in working with veterans comes from the number of veterans who have PTSI. Dr. Lipov told Medical Daily that 25% of combat veterans and 90% of women who are sexually abused during military service experience PTSI.
His nerve block treatment is applied at two places on the neck. Part of the stress response, Dr. Lipov said, includes sprouting of numerous nerve fibers. These fibers release norepinephrine, which then causes the person to be stuck in the fight or flight response. This treatment works by trimming the nerve fibers and preventing the growth of new fibers. The norepinephrine production drops off and the patient’s symptoms improve. Dr. Lipov has been collecting treatment data and expects to have his work submitted for peer review in the near future.
As Covid-19 is a neuro-toxic virus, as evidenced by loss of smell and taste, Dr. Lipov believes the nerve block will help those who are experiencing PTSD from Covid-19.
Noninvasive Vagus Nerve Stimulation (nVNS)
A study suggests that vagal nerve stimulation can decrease activity in parts of the brain that are involved in visualizing a previous traumatic event. The participants had a history of psychological trauma but did not have PTSD. They listened to stressful stories that activated areas of the brain that are known to respond to stress. A handheld device was used to apply a mild electrical charge to the neck and vagus nerve. A sham device that felt the same but did not apply an electrical charge to the vagus nerve in the neck was also used. The participants were in a PET scan when the handheld devices were used. The PET scan showed that there was less brain activity when the vagus nerve was stimulated with the electrical current than with the sham device. This decreased activity in the areas of the brain that perceive stress, resulted in fear reduction with long lasting effects, and shows promise of help for PTSD victims.
There is evidence to show that mindfulness training can significantly reduce PTSD and the severity of depression. One hundred veterans were arranged into 4 groups. The first group participated in a self body-scan. Here, they were directed to focus on different areas of the body and become aware of the various sensations. The mindful breathing group listened to a guided meditation with a focus on breathing. The third group focused on slow breathing and the fourth group sat quietly. The only group that did not experience a reduction in symptoms was the slow breathing group.
There is mixed evidence as to the impact of yoga on PTSD symptoms. However, there is evidence that yoga tailored to a military application is effective in reducing the severity of PTSD symptoms. Given the different types of yoga and practices available one geared to the unique needs of those struggling with PTSD might be more effective.
Make a Movie
There are programs that allow PTSD victims to create a video to tell their story in a way that gives them control over the story. There are also programs that allow the person to make a video in which the traumatic event is re-written so that the new image replaces the stressful memory, thereby reducing the stressful reaction to that memory.
There is a growing body of evidence that psychedelics have a role in treating PTSD. Recently the FDA approved two psychedelics for use in psychiatric cases and several more are being considered for PTSD.
Gregory Hammer, MD, professor, Anesthesiology, Perioperative and Pain Medicine, and Pediatrics, Stanford University School of Medicine told Medical Daily that the treatment of PTSD is not one-treatment-fits-all. Patients are unique individuals with unique responses to treatment. For example, norepinephrine and nerve growth factor — an important agent that helps with the growth, survival and specialization of neurons — play various roles during a stress response. They activate some responses and damp down others. Too much or too little can get the body out of balance, so finding the perfect balance is tricky.
Dr. Hammer said he believes that there is merit in using hallucinogens in the treatment of PTSD to help rewire brain circuitry, thereby reducing the impact of the memory of traumatic events.
There is growing evidence that people can change how their mind works by being conscious of their thoughts. This is an area worthy of exploration to help patients change the impact of traumatic memories and improve their PTSD.
Yvonne Stolworthy MSN, RN graduated from nursing school in 1984 and has spent many years in critical care and as an educator in a variety of settings, including clinical trials.