May 31, 2013
Trigeminal Nerve Stimulation May Aid in PTSD
May 31, 2013
HOLLYWOOD, Florida — Trigeminal nerve stimulation (TNS), a noninvasive therapy currently approved for treatment of refractory epilepsy and major depression in Canada and Europe, is showing promise in the treatment of posttraumatic stress disorder (PTSD) and concomitant depression, according to the results of a small pilot study.
In the 8-week open-label outpatient trial, 12 adults with severe and long-standing PTSD and depression showed a significant reduction in the anxiety symptoms of PTSD, as measured by the PTSD Patient Checklist as well as symptoms of depression, as measured by the Quick Inventory of Depressive Symptomatology .
"We think that it works by sending signals in through the trigeminal nerve into the brain stem," reports
lead author Ian A. Cook, MD,
"From there, the signals can influence the activity in the centers of the brain that produce serotonin and norephinephrine, and also send signals to the anterior cingulate, the amygdala, the areas of the brain that are very important for things like emotional regulation and anxiety. We have PET [positron emission tomography] study data in humans showing that we can change the level of activity in these areas with stimulation through this pathway," Dr. Cook said.
Also Helpful in ADHD?
Trigeminal nerve stimulation may also be an option for the treatment of attention-deficit/hyperactivity disorder (ADHD), Dr. Cook said.
Earlier this month, at the American Psychiatric Association's 2013 Annual Meeting, he presented the results of a small pilot trial that showed good results with TNS as stand-alone therapy in treatment-naïve patients aged 7 to 14 years with ADHD.
As reported, that trial showed improvement in patient-, parent-, and investigator-reported ADHD symptoms and executive function, as well as cognitive function, as assessed by computerized testing.
In the current study, 12 adults with concomitant PTSD and depression wore the TNS device for 8 hours a night in addition to taking their usual medications.
The patients ranged in age from 31 to 59 years (mean, 52.8 years) and had a current episode of major depression lasting at least 4 weeks that was nonresponsive to 6 or more weeks of antidepressant therapy. Traumatic exposure occurred 3 to 61 years ago (median, 37 years).
"The device consists of an electronic patch that goes on the forehead and stimulates the supraorbital branches of the trigeminal nerve. It plugs into a small generator that looks like a large cell phone or iPod, and patients can either wear it in a pocket or put it under their pillow, whatever is convenient. The next morning they take off the patch and use a fresh one the next night at bedtime," Dr. Cook explained.
He and his team report "impressive" reductions in PTSD and depressive symptoms.
"The nightmares, the flashbacks, the hyperarousal all got better. Some of these people had suffered from severe PTSD for a very long time, the median was 37 years, but by the end of the 8 weeks, these were significantly reduced from baseline," Dr. Cook said.