Post-traumatic stress disorder (PTSD) is a debilitating mental health condition affecting millions worldwide. According to the U.S. Department of Veteran’s Affairs, approximately 6% of the U.S. population will experience PTSD at some point. The condition can arise from traumatic events, such as combat, natural disasters, accidents, or personal assaults. Fortunately, there is hope for those suffering from PTSD, as integrative and functional medicine approaches can offer effective, evidence-based treatments tailored to individual needs.

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What is PTSD

Post-traumatic stress disorder (PTSD) is a complex psychological condition that may manifest in individuals after exposure to or witnessing intensely distressing events, such as acts of terrorism, warfare, vehicular accidents, natural disasters, or criminal activities. In certain instances, the precipitating event may not be directly life-endangering, such as the unexpected bereavement of a close relation. Irrespective of the nature of the event, it is typical for individuals to experience heightened anxiety and apprehension during and following such occurrences. Upon being confronted with a traumatic situation, the human body initiates a "fight-or-flight" response with the intent to shield itself from danger. This reaction triggers a series of physiological alterations, including increased alertness, heart rate, blood pressure, and hormone release.

Unfortunately, for some individuals, the fear, stress, and anxiety persist long after the traumatic event has occurred. They may experience vivid, painful memories, flashbacks, or nightmares, causing them to relive the trauma repeatedly. Additionally, they might avoid places or activities that remind them of the event and struggle with symptoms like difficulty concentrating, memory issues, disturbed sleep, and an exaggerated startle response. Guilt- associated with surviving a traumatic event when others didn't- can also be overwhelming for those affected by PTSD. People with PTSD may continue to feel stressed and frightened, even when they're not in danger. In some instances, PTSD symptoms may not manifest immediately but can appear later or come and go over time (3,4,5).

Symptoms of PTSD

The experience of PTSD is a complex and deeply personal journey that uniquely affects individuals. Symptoms of PTSD generally emerge soon after the traumatic event, but they can also be delayed for months or years and can fluctuate over time. If the symptoms persist for more than four weeks, significantly impact your well-being, or interfere with your daily life, you may be dealing with PTSD. There are four primary types of PTSD symptoms, though they may manifest differently for each person:

Reliving the Traumatic Event (Re-Experiencing Symptoms)

Traumatic memories can resurface at any time with PTSD, often feeling incredibly real and frightening. Nightmares, flashbacks, and triggers—such as specific sights, sounds, or smells—can cause individuals to relive the event (6).

Avoidance of Reminders

People with PTSD may avoid situations, people, or thoughts that remind them of the traumatic event to protect themselves from reliving the experience. This avoidance can manifest in various ways, such as steering clear of crowds, refraining from driving after a car accident or keeping excessively busy to prevent dwelling on the trauma (6).

Negative Thoughts and Feelings  

Traumatic experiences can significantly alter one's perspective on themselves and others, leading to more negative thoughts and feelings. Individuals with PTSD may struggle with feelings of numbness, guilt, or shame, have difficulty trusting others, or even lose interest in previously enjoyable activities (6).

Feeling on Edge (Hyperarousal)  

PTSD can cause people to feel constantly alert and on the lookout for danger, leading to irritability, difficulty sleeping, or concentration problems. This heightened state of arousal might prompt individuals to engage in unhealthy behaviors such as substance abuse, smoking, or aggressive driving (6).

What Causes PTSD?

The exact etiology of PTSD has yet to be definitively established; however, researchers believe that an intricate interplay of neurobiological, risk, and individual factors can contribute to the emergence. Not everyone who experiences a traumatic event will get PTSD; most of those exposed to such experiences will not.

However, certain risk factors can increase the likelihood of developing PTSD, such as the intensity, duration, or type of traumatic event, personal factors like age, gender, and race, and the stress level experienced after the event. Pre- and peri-trauma risk factors for PTSD include a history of prior trauma exposure, less education, lower socioeconomic status, childhood adversity (including childhood trauma or abuse), personal and family psychiatric history, gender, race, poor social support, physical injury (including traumatic brain injury) as part of the traumatic event, and the initial severity of the reaction to the traumatic event.

Intentional trauma, or trauma carried out for an intended purpose on a particular individual, has been demonstrated to exhibit a stronger correlation with PTSD compared to unintentional or non-assaultive traumatic events; moreover, a heightened duration of exposure to trauma is associated with an increased risk of developing PTSD. While females are twice as likely to develop PTSD as males when accounting for exposure to traumatic events, the prevalence of PTSD is comparable between the genders following events such as accidents, natural disasters, and the unexpected death of a close relation. Conversely, resilience factors can aid in mitigating the risk of PTSD development. These include seeking support from friends and family, participating in support groups post-trauma, maintaining positive self-perception in the face of danger, employing adaptive coping strategies, and demonstrating effective action and response despite experiencing fear (7).

Functional Medicine Labs to Test for Patients Suffering from PTSD

Many functional medicine labs can aid in the treatment and recovery of PTSD. Examining cortisol, neurotransmitter, and hormone levels, we can gain valuable insights into the complex neurochemical and hormonal factors involved in PTSD, guiding effective treatment strategies.

Cortisol Testing

The Genova Adrenocortex Stress Profile is a valuable tool for examining cortisol levels, which may be associated with PTSD. Research has shown that cortisol levels and their patterns can provide insight into the presence and severity of PTSD in individuals. For example, one study found that women with lifetime PTSD due to intimate partner violence had significantly higher cortisol levels across the day when compared to abuse-exposed participants without PTSD, suggesting that elevated cortisol levels may be a biomarker of PTSD related to intimate partner violence. Addressing elevated cortisol levels in PTSD patients is essential to treatment, as these imbalances can exacerbate stress responses, contribute to sleep disturbances, and negatively impact overall mental and physical health.

Neurotransmitter Testing and PTSD

Studies have demonstrated that neurotransmitters, including serotonin and norepinephrine, are critical for regulating stress, anxiety, and mood—factors frequently impacted in individuals with PTSD, resulting in abnormal levels.

Sleep and Stress Hormone Testing in PTSD

The DUTCH Complete Dried Urine test offers a valuable resource for assessing critical hormone levels in individuals, providing essential insights into the factors involved in PTSD. A study examining the nocturnal salivary melatonin profiles of personnel with PTSD found that affected individuals displayed blunted nocturnal melatonin secretion compared to healthy controls. This finding suggests that dysregulated melatonin secretion may be associated with sleep disturbances in PTSD patients. This test also screens for elevated cortisol levels, which may play a role in PTSD symptoms, as described above.

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Complementary and Integrative Medicine Treatment for PTSD

A growing body of evidence supports the use of various complementary and integrative medicine approaches to address the underlying causes and alleviate symptoms of PTSD. Some of these treatments include:

Different Types of Therapy for PTSD

According to clinical trials and meta-analyses, trauma-focused psychotherapies, such as cognitive-behavioral therapy (CBT), prolonged exposure therapy, and eye movement desensitization and reprocessing (EMDR) therapy, are the most extensively studied and effective treatments for PTSD. A meta-analysis of five trials found that treatment with cognitive processing therapy, like exposure therapy, reduced PTSD symptoms more effectively than a control group that received no treatment or placebo. Prolonged exposure therapy has been found effective in treating PTSD symptoms. One study concluded that 66% of individuals who participated in exposure therapy no longer qualified for a PTSD diagnosis when compared to control groups.

Acupuncture for PTSD

Acupuncture, a technique involving the insertion of needles into specific acupoints, has shown the potential to alleviate PTSD symptoms. Research indicates that acupuncture can modulate the limbic system, regulate neurotransmitters, and improve sleep quality, all of which are relevant to PTSD. Studies have demonstrated the effectiveness of acupuncture in reducing PTSD symptoms when compared to controls or when combined with cognitive-behavioral therapy (CBT). For example, a 12-week randomized controlled trial found that acupuncture and CBT outperformed a waitlist control in reducing PTSD symptoms in civilian patients. Additionally, a study involving earthquake survivors showed that a combined CBT-acupuncture treatment produced significantly better results than CBT alone.

The Acupuncture NADA Protocol for PTSD

The Acupuncture NADA (National Acupuncture Detoxification Association) protocol is a recognized treatment approach utilized for individuals suffering from post-traumatic stress disorder (PTSD). This protocol, rooted in the principles of Traditional Chinese Medicine, involves the insertion of fine needles into specific points on the ear to address various symptoms associated with PTSD. The NADA protocol focuses on five specific points: the sympathetic point, shen men point, kidney point, liver point, and lung point. These points are believed to regulate the body's energy flow, promote relaxation, alleviate anxiety, reduce cravings, and enhance overall well-being. The NADA protocol is often used in conjunction with other therapeutic interventions as part of a comprehensive treatment plan for individuals seeking relief from the debilitating effects of PTSD. By stimulating these acupuncture points, the NADA protocol offers a non-invasive and drug-free approach to support individuals in their journey towards healing and recovery from PTSD. This protocol is commonly taught to non-acupuncturist in the behavioral health field, and is also used in many Veteran Affairs clinics throughout the U.S due to its success in reducing the affects of PTSD and the symptoms associated with it.

Yoga and Mindfulness for PTSD

Mindfulness and yoga practices have shown the potential to address PTSD symptoms by reducing the stress response and promoting mental health. Mindfulness-based interventions, including yoga and meditation practices, have improved symptoms and mental health-related quality of life for veterans with combat PTSD. These practices are thought to reduce the allostatic load in stress response systems, restoring optimal homeostasis.

Yoga, a mind-body therapy involving physical positions, breathing, and meditation, has improved PTSD symptoms among various populations. Studies involving Iyengar yoga and Sudarshan Kriya yoga (SKY) have shown promising results in alleviating PTSD symptoms. For example, a non-randomized controlled trial with 183 survivors of the 2004 Asian tsunami found that SKY alone and SKY followed by exposure therapy were more effective than the control.

Qigong, a form of gentle exercise like yoga, is a mind-body discipline, and the foundation of traditional Chinese medicine has been increasingly recognized for its various health benefits. Studies have shown that qigong can reduce oxidative stress, improve blood lipid metabolism, prevent bone loss, and enhance mood, sleep, cognitive function, and emotional regulation. Although few studies have specifically examined qigong for PTSD, one study found that qigong practice was associated with reduced PTSD symptoms.

Exercise for PTSD

Numerous investigations have found that physical activity may yield favorable outcomes for individuals afflicted with PTSD. For example, a randomized controlled trial demonstrated that exercise resulted in a substantial reductions in PTSD symptomatology. Another randomized controlled trial found that a two week aerobic exercise regimen significantly diminished PTSD symptoms, depression, and anxiety. Moreover, a systematic review and meta-analysis encompassing various studies found that physical activity can function as an efficacious adjunctive treatment for PTSD, contributing to reductions in symptom severity and enhancements in overall mental well-being.

Nutrition for PTSD

Proper nutrition carries the potential to help patients with PTSD. It has been found that consuming foods rich in phytochemicals helps reduce oxidative damage in the brain. One type of diet that is nutrient-rich in this manner is the Mediterranean diet. With poor nutrition, damage can occur in nerve cells, leading to adverse effects on memory, mood, and cognitive functioning. Furthermore, chronic stress, as experienced by individuals with PTSD, can cause long-term inflammation in the brain, resulting from an overactive stress response and oxidative stress damage from free radicals on nerve cells. Chronic stress, like that experienced in PTSD, can cause long-term brain inflammation due to an overactive stress response and damage from free radicals on nerve cells. Therefore, eating a diet that is of high quality and reduces inflammation can be vital for improving health in this patient population.

Supplements and Herbs for PTSD

Ginkgo biloba, fish oil, and melatonin are supplements that show promise in supporting individuals with post-traumatic stress disorder (PTSD) as part of a comprehensive treatment plan.

Ginkgo Biloba for PTSD

Ginkgo Biloba, a herbal supplement with neuroprotective and antioxidant properties, has demonstrated the potential to help individuals with PTSD. A 12-week, double-blind study found that adding 200mg of Ginkgo Biloba to existing PTSD treatments significantly improved PTSD symptoms, anxiety, depression, general health, and perceived stress levels. These benefits persisted even four weeks after discontinuing the supplement, with no significant differences in side effects observed.

Fish Oil for PTSD

Fish oil may be beneficial to patients with PTSD. One study discovered that a 12-week supplementation of omega-3 fish oil (70% DHA and 7% EPA) led to improved PTSD symptoms among female medical assistance team workers by reducing inflammation in the body. This finding suggests that omega-3 fatty acids may play a role in alleviating PTSD symptoms.

Melatonin for PTSD

Melatonin, a hormone naturally produced by the pineal gland, is known for regulating sleep-wake cycles and circadian rhythms. It has been demonstrated that individuals with post-traumatic stress disorder (PTSD) have severely blunted nocturnal melatonin secretion. This is thought to add to disruptive sleep cycles and can lead to a worsening of psychological symptoms. Melatonin is well-known as an effective sleep aid to help people fall asleep and stay asleep longer. It has the potential to help regulate sleep in those with PTSD and may help patients suffering from sleep disturbances.

Traditional Chinese Herbal Formulas for PTSD

Chai Hu Jia Long Gu Mu Li Wan is a traditional Chinese medicine formula commonly used to "calm and sedate the spirit quickly." Its actions tranquilize the mind and are frequently used to treat anxiety, irritability, insomnia, and a fullness sensation in the chest.

Another frequently used Chinese herbal formula is Suan Zao Ren Tang, commonly prescribed to support the nervous system, promote relaxation, and improve sleep quality.

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Summary

PTSD is a complex mental health condition that affects millions of individuals worldwide. While the primary cause is exposure to a traumatic event, various genetic, biological, and environmental factors can contribute to the development and severity of the disorder. A comprehensive, integrative approach to treatment, including evidence-based therapies, supplements, herbs, and lifestyle modifications, can help support healing and recovery for those who have PTSD. By addressing the underlying causes and contributors, individuals with PTSD can regain control of their lives and move toward a brighter, healthier future.