The Walking Wounded: Emerging Treatments for PTSD

Purpose of Review

We review the published literature over the last 24 months in the treatment of PTSD for our military men and women. We examined the updated clinical practice guidelines published in June 2017 by the Veteran’s administration and Department of Defense and contrasted the guidelines with the most recent literature. We also discuss new directions in PTSD research.

Recent Findings

Psychotherapy remains one of the most effective treatments for PTSD; unfortunately, few participants remain in treatment to completion. Many of the emerging therapies target NMDA receptor antagonists, cannabinoid receptor modulators, glucocorticoid receptor agonists, non-SSRI antidepressants, and opioid receptor agonists. The newer therapies fall into the drug classes of anti-hypertensives, glutamate modulators, oxytocin, and medication targeting insomnia/hyperarousal.

Summary

PTSD symptoms are often chronic in our veteran population. While current treatments are helpful, there are often significant residual symptoms. We reviewed the most recent improvements in treatment and discuss therapies that are in the research phase.

     

Carcinogenicity testing of black pepper (Piper nigrum) using the Egyptian toad (Bufo regularis) as a quick biological test animal

Milled black pepper (Piper nigrum) force-fed to Egyptian toads as a suspension in amphibian saline or injected subcutaneously in the dorsal lymph sac as an ethanol extract, induced primary tumours in the liver and secondary tumours in other organs (kidney and spleen). When applied to the skin of experimental animals as an ethanol extract, black pepper induced primary tumours in the liver and secondary tumours in the ileum and stomach. Tumours of the liver were diagnosed as hepatocellular carcinomas and those of the other organs as metastases of the primary liver tumours. It is speculated that one or more constituents of black pepper may be responsible for tumour induction in the organs of the Egyptian toad Bufo regularis.     

Effect of ebony and yellow mutants of Drosophila melanogaster on adult survival and alcohol dehydrogenase activity

The survival of ebony, yellow, ebony-yellow double mutant and their wild type was studied on two types of media. All genotypes showed greater survival in the presence of 10% ethanol (E) than on the control agar medium (C), with wild type showing greatest and the double mutant ebony-yellow least response. This increase in survival on E was negatively dependent on that on C. The relationship between alcohol dehydrogenase (ADH) activity and survival appeared to be negative on E. On C it was either slightly positive for males or constant for females. The degree of survival increase standardized in relation to survival on C [(E-C)/C] was more dependent on the level of ADH activity for the males (r = -0.98; p greater than 0.05) than for the females (r = -0.38; NS). In the complex interaction between morphogenes, ADH activity and survival, morphogenes increased the ADH activity and decreased survival on E.     

Effect of combined low dose praziquantel and oxamniquine on different stages of schistosome maturity

Combined low doses of praziquantel and oxamniquine were tested against different stages of Schistosoma mansoni in infected Swiss albino mice. The effect of combination therapy (1/3 the curative dose of praziquantel plus 1/3 the curative dose of oxamniquine) was compared with the effect of each drug alone, in reduced or full dose. Comparison with infected untreated controls was also made. Drug effects were evaluated on different growth stages of schistosomes by administering the drugs 24 h before infection and 4 h, 1, 2, 3, 4 and 5 weeks after infection. Animals were killed 8 weeks after infection. Worm burden, distribution, tissue egg load and oogram pattern were used in assessing drug efficacy. A potentiating effect was observed in animals receiving combination therapy. The combination regimen was most effective 4 h after infection, producing 96% worm reduction; eggs were not detected in the liver or intestine. Five weeks after infection the same regimen resulted in 98% reduction in the tissue egg load.     

New biphenyl derivatives i: 1-(4-biphenylyl)-2-phenylethylamines as potential antispasmodic and cardiovascular agents

A series of 1-(4-biphenylyl)-2-phenylethylamine derivatives was synthesized as potential antispasmodic and cardiovascular agents related to papaverine. Preliminary pharmacological tests, on isolated guinea pig ileum and anesthetized cat blood pressure, showed that the new compounds possess nonspecific inhibitory action on smooth muscles.