Dr. Schiller has updated his very popular article on the role medications play in trauma treatment. First published in 2016, one might argue that this update including TMS and Ketamine treatments, is even more relevant today.
Ketamine.
There has been quite a lot of interest in the use of ketamine in the treatment of depression. Ketamine has been used since the 1970’s primarily as an anesthetic. It is an NMDA receptor antagonist which accounts for much of its activity and its actions as a hallucinogen and dissociative agent. The latter also accounts for its potential for abuse. However, other effects of ketamine, perhaps a transient increase in glutamate transmission and causing an increase in the connectivity of neurons, may account for ketamine’s ability to act as an antidepressant. There is also research into the use of ketamine in the treatment of PTSD. In the most prominent studies, depressive symptoms, often present in people with PTSD did improve, but there were inconsistent results in whether specific symptoms of PTSD improved.
TMS (Transcranial Magnetic Stimulation).
While not a medication treatment, repetitive transcranial magnetic stimulation (rTMS or TMS) is a physical treatment which is approved for the treatment of depression. In TMS, a magnetic coil is placed over a targeted area of the head. A magnetic field goes through the skull and causes a small electric current in the brain in an area associated with depression. This area is connected to other parts of the brain which may also be secondarily stimulated and likely treat depression through increasing connections between neurons. TMS is being investigated as a treatment in a number of other psychiatric disorders including PTSD. Studies appear consistent in showing improvement in depressive symptoms in PTSD. Though further research needs to be done to draw more definitive conclusions, a number of studies have shown TMS to be well tolerated and effective in treating some of the specific symptoms of PTSD.
