Top: Army Sgt. Margaux Mange experienced severe PTSD symptoms after serving in Iraq. She says hyperbaric oxygen therapy helped her symptoms significantly improve. Visual: Courtesy Margaux Mange
The unapproved and, to some, unproven treatment is attracting many PTSD patients for whom other treatments have failed.
BY GITIT GINAT
IN 2007, United States Army Sgt. Margaux Mange was driving through Baghdad when the Humvee behind hers was hit with a bomb. She recalls grabbing a fire extinguisher and running toward the vehicle to try to rescue her best friend. But Mange was pulled back from the wreckage. Days later, Mange recalled, her left eye stopped blinking. A doctor told her it was Bell’s palsy, a form of temporary facial paralysis that may be triggered by stress. “I had a huge amount of survivor’s guilt,” she wrote in a text message to Undark.
Guilt wasn’t the only thing troubling Mange. Prior to her friend’s death, the blast from an improvised explosive device had thrown Mange’s head back into the turret of her vehicle, giving her a severe concussion and ultimately a traumatic brain injury, she said. In addition to receiving the Bell’s palsy and TBI diagnoses, Mange was told that certain nerves were damaged along one side of her head. She was flown to Denver, Colorado, for brain surgery. Back home in the United States, Mange realized her health was worse than anyone had imagined. She was besieged with excruciating headaches and had been diagnosed with a number of conditions, including post-traumatic stress disorder. “I had constant nightmares,” Mange wrote, and “no desire to leave bed.”
She went to psychotherapy and took a litany of prescription drugs — several pills for PTSD, she recalls, and several more for migraines and nerve pain. The drug regimen included powerful and potentially addictive pain relievers, such as morphine patches, oxycodone, and Vicodin, Mange wrote to Undark, as well as sleeping pills. “I’m not sure if my many doctors were talking to each other about the medications, and how they might be overlapping or cancelling each other out.”
According to the Department of Veterans Affairs, anywhere from about 7 to 30 percent of U.S. combat veterans experience PTSD, a condition that emerges following an event in which a person experiences or witnesses something extreme — like the brutal killing of a friend. Symptoms may include nightmares, flashbacks, and severe anxiety. Among veterans, the most common treatment is a prescription drug, usually a type of antidepressant called an SSRI. However, many PTSD patients do not respond to these medications, and by one estimate, fewer than 20 to 30 percent of patients treated with SSRIs achieve full remission.
This situation is compounded by the fact that veterans with PTSD have high rates of co-occurring conditions, including depression, anxiety, substance misuse, and chronic pain. Like Mange, they are often prescribed multiple medications at once, a phenomenon known as polypharmacy, which increases the likelihood of side effects and drug-drug interactions.
Unsatisfied with her medication regimen and still struggling with both TBI and PTSD symptoms, Mange said she spoke with an Army counselor, who helped her enroll in a small study to test the effectiveness of a treatment often associated with undersea medicine: hyperbaric oxygen therapy. HBOT is a decades-old treatment in which patients enter a pressurized chamber and breathe pure oxygen, usually for about two hours. The oxygen saturates the blood and circulates throughout the body. This process has been shown to reduce inflammation and promote the development of new blood vessels, though the precise mechanisms are not fully understood.
“I had constant nightmares,” Mange wrote, and “no desire to leave bed.”
According to the VA, there is not a single rigorous study showing that HBOT alleviates the symptoms of PTSD. The U.S. Food and Drug Administration has not approved the treatment for mental health disorders, and insurance rarely covers HBOT for these conditions. Hyperbaric oxygen therapy also has a fraught history in the U.S., where it has a reputation as a pricey intervention with a weak evidence base, even for some of its approved uses.
But a handful of small studies — mainly conducted by physicians with ties to HBOT clinics — suggest that hyperbaric oxygen may improve PTSD symptoms and traumatic brain injuries in some patients, with limited side effects. These early results, coupled with hopeful anecdotes, have sparked intense interest and advocacy from veterans and their supporters, who are looking for better ways to treat the lingering wounds of war.
HYPERBARIC OXYGEN THERAPY was used in the 1930s to treat decompression sickness, a rare condition often associated with deep-sea diving. In the ensuing decades, physicians published clinical reports of their experiences using HBOT for a wide variety of purposes. As research uncovered the important role of oxygen in tissue repair, HBOT’s use as a treatment for chronic wounds became more common. In 2002, the Centers for Medicare & Medicaid Services decided to reimburse for treatments to heal diabetic foot ulcers. From there, the therapy took off…