Identifying effective treatments for veterans with posttraumatic stress disorder (PTSD) has been one of the top priorities for the military and veteran mental health communities. Currently, there are only two medications (paroxetine and sertraline) approved for PTSD and just a few talk therapies that are considered bona fide treatments (e.g., exposure, cognitive therapy).
Indeed, there is a deficiency when it comes to treatment choices for veterans. Then there is the issue of tolerability. Many Veterans Quit Treatment
Many veterans who are prescribed medication quit because of the side effects. Some of the more common ones are stomach upset, agitation, sweating, insomnia and emotional numbing. And then there are the sexual side effects. As you might expect, reduced sex drive and the inability to achieve an orgasm-common side effects of PTSD medications-can be quite troubling for a soldier in the prime of his life. And it is not just men that experience these side effects. It is not uncommon to hear females complain of low libido while taking these medications.
There are problems with the most popular talk therapies as well. Treatments like Prolonged Exposure and Eye Movement Desensitization and Reprocessing are challenging for many veterans. These treatments require the veteran to relive the trauma, and in some cases, emotionally and physically re-experience the trauma in session.
Recent research has shown that a substantial number of veterans drop out of these treatments prematurely; up to half in some cases. And for those who are able to complete treatment, questions about long-term effectiveness have been raised. Even when outcome scores on PTSD measures drop during treatment, most veterans continue to experience enough severe symptoms to retain the PTSD diagnosis. Unlike previous claims about talk therapies “curing” PTSD, it appears the results were overstated.
Reasonable Alternatives To Traditional Treatments
As a result of growing concerns about availability, tolerabilit, and effectiveness of traditional PTSD treatments, interest in alternative therapies has grown at a breakneck pace. In previous columns, I have written about the popularity of techniques like yoga, transcendental meditation, mixed martial arts, and equine therapy.
I have even written about entire organizations like Boulder Crest Retreat, a civilian, non-profit group dedicated to these types of therapies. Boulder Crest Retreat is the first rural, non-profit wellness center for veterans. Based in Bluemont, Virginia, Boulder Crest is currently collecting program evaluation data in hopes of identifying the scope of impact it is having on program attendees.
What Is The Hold-Up?
So why are these alternative and non-traditional treatments still considered alternative and non-traditional? It is pretty simple. There is a lack of evidence.
Regardless of how innovative and cutting-edge they are, new therapies must be backed by sound science before they are accepted into mainstream healthcare. This hesitation is for good reason. Before introducing a new treatment to the public, we need to be sure that it is safe and effective. And the only way to do this is through clinical research.
The Unintended Consequence
There is an unintended consequence, however. Although the need for therapies and programs to be backed by science is important, it prevents effective treatments from reaching those most in need in a timely manner.
Scientifically assessing the merits of a new therapy or program can take many years and a substantial financial investment. For example, a randomized clinical trial is considered the “gold standard” when it comes to clinical research. However, this type of study can cost hundreds of thousands, if not millions of dollars to complete.
And depending on the type of study and research question being asked, it could take years before enough data is obtained to make a definitive claim about the results. The reality is that few organizations outside of universities, corporations or the government have the finances, staff and time to oversee such a tremendous undertaking.
It Can Be Fixed
There is a solution. Private and public sector collaboration is the key to bringing safe and effective therapies and programs to the market in a timely manner. We need a marriage between the innovative and entrepreneurial spirit of our private citizens and the funding and accountability of our government. This collaboration is our best chance to meet the needs of those who have sacrificed so much for our country.
It’s not an easy fix, however. Because of regulatory and bureaucratic challenges, private and public partnerships are difficult to construct. It takes an unwavering commitment on both sides and much flexibility. Unfortunately, this is not the current state of affairs in our country.
*This article is based on a previous column written by Dr. Moore and published in Military Times.