The use of hyperbaric oxygen for veterans with PTSD: basic physiology and current available clinical data

Abstract

Post-traumatic stress disorder (PTSD) affects up to 30% of veterans returning from the combat zone. Unfortunately, a substantial proportion of them do not remit with the current available treatments and thus continue to experience long-term social, behavioral, and occupational dysfunction. Accumulating data implies that the long-standing unremitting symptoms are related to changes in brain activity and structure, mainly disruption in the frontolimbic circuit. Hence, repair of brain structure and restoration of function could be a potential aim of effective treatment. Hyperbaric oxygen therapy (HBOT) has been effective in treating disruptions of brain structure and functions such as stroke, traumatic brain injury, and fibromyalgia even years after the acute insult. These favorable HBOT brain effects may be related to recent protocols that emphasize frequent fluctuations in oxygen concentrations, which in turn contribute to gene expression alterations and metabolic changes that induce neuronal stem cell proliferation, mitochondrial multiplication, angiogenesis, and regulation of the inflammatory cascade. Recently, clinical findings have also demonstrated the beneficial effect of HBOT on veterans with treatment-resistant PTSD. Moderation of intrusive symptoms, avoidance, mood and cognitive symptoms, and hyperarousal were correlated with improved brain function and with diffusion tensor imaging-defined structural changes. This article reviews the current data on the regenerative biological effects of HBOT, and the ongoing research of its use for veterans with PTSD.

Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial

“…Beyond improvements in pain-related symptoms, the enhanced emotional state observed post-HBOT—characterized by reduced PTSD symptoms and depression rates and intensity—may further enhance daily functioning. Those results are in line with previous studies with veterans suffering from combat related PTSD 31 – 33 as well as the previous results from study done on FMS related CSA 20 , 42 . In longitudinal evaluation of these veterans with combat-related PTSD, it was demonstrated that the beneficial effects of HBOT persisted even two years after treatment 31 .…”

“…A growing body of evidence suggests that the pathophysiological changes resulting from traumatic events can lead to enduring alterations in brain structure and function. These alterations encompass abnormalities in the prefrontal cortex (PFC), the anterior cingulate cortex and the limbic system, as well as impaired connectivity—both functional and structural—between the amygdala, hippocampus, and frontal lobes 33 , 36 , 37 . CSA, characterized by traumatic exposures during maturation, can negatively impact brain development, connectivity, and functionality, making it a risk factor for long-term psychopathology 38 .…”

“…The beneficial effects of HBOT have been demonstrated in individuals with persistent impaired brain functions, even years after an acute insult, across various populations such as post-stroke, post-concussion, and post-COVID patients 21 , 22 , 25 – 30 . HBOT protocols have also shown promise in inducing neuroplasticity and improving clinical symptoms in veterans with treatment-resistant military-related post-traumatic stress disorder (PTSD) 31 – 33 . Furthermore, HBOT has emerged as a promising modality for a subgroup of FMS patients who developed the syndrome following severe emotional stress, including childhood abuse 20 , 34 .…”