A recent study published in The Journal of Clinical Psychiatry indicates that hyperbaric oxygen therapy (HBOT) can significantly alleviate symptoms of combat-associated posttraumatic stress disorder (CA-PTSD) in veterans. The randomized, sham-controlled trial, conducted at the Sagol Center for Hyperbaric Medicine and Research in Israel, offers new hope for veterans who have not found relief through conventional treatments.
The study, which ran from February 2020 to July 2023, involved 63 male veterans aged 25–60 years with CA-PTSD. Participants were randomly assigned to receive either HBOT or a sham intervention. The HBOT group received 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes daily, with short air breaks, while the sham group received 21% oxygen at 1.02 ATA for the same duration. Both groups underwent 60 daily sessions.
The primary endpoint was a 30% reduction in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score from baseline. Secondary endpoints included changes in PTSD symptom load, depression severity (measured by the Beck Depression Inventory II), and anxiety and stress levels (measured by the Depression, Anxiety and Stress Scale 21-Item questionnaire). Resting-state functional MRI (rsfMRI) was used to assess brain connectivity.
Significant Symptom Reduction with HBOT
The HBOT group showed a significant decrease in mean CAPS-5 total score, from 42.57 to 25.8 post-treatment (P < .001). In contrast, the sham group showed an increase in CAPS-5 total score from baseline to follow-up (P = .011). Treatment response rates, defined as a 30% reduction of CAPS score from baseline, were 68% in the HBOT group versus 4% in the sham group (P < .001).
"These findings suggest that HBOT can offer substantial relief for veterans struggling with the debilitating symptoms of combat-related PTSD," said Dr. Keren Doenyas-Barak, the study's corresponding author from the Sagol Center.
Enhanced Brain Connectivity
RsfMRI analysis revealed improved connectivity within key brain networks in the HBOT group compared to the sham group. Specifically, there was increased functional connectivity within the default mode network, the salience network, and the frontoparietal network. These networks are known to be disrupted in individuals with PTSD.
Safety and Tolerability
Both HBOT and sham treatments were well-tolerated. The most common adverse events were mild and self-limited, including ear pain and tympanic membrane redness. Seven subjects in the HBOT group reported surfacing of new memories during the HBOT course, a phenomenon that resolved with professional advice.
Implications for PTSD Treatment
Despite advancements in psychological and pharmacological treatments, many individuals with PTSD do not experience remission. This study suggests that HBOT could be a valuable adjunct therapy for veterans with CA-PTSD who have not responded to first-line treatments.
"HBOT presents a novel therapeutic approach for PTSD, targeting the biological consequences of traumatic events," the authors concluded. "The treatment’s safety profile and efficacy support its use for veterans not responding to psychotherapy."
Study Details
The HBOT protocol consisted of 60 daily sessions, five days per week, with 90 minutes of 100% oxygen at 2 ATA, including 5-minute air breaks every 20 minutes. The sham protocol involved 90 minutes of 21% oxygen at 1.02 ATA. The study was registered with ClinicalTrials.gov (NCT04518007).
While the study's authors recommend adhering to the specific HBOT protocol used in the trial, they also caution against using hyperbaric treatments in non-medical grade facilities or without a professional multidisciplinary medical team due to the potential for symptom worsening and memory surfacing during the treatment course.
