Drug-Free Alternatives for Post-Traumatic Stress Disorder (PTSD)
Mary M. Ernsberger
HERB503 – Advanced Herbal Materia Medica II
American College of Healthcare Sciences
Stress is a primary causative factor that scientific research has shown leads directly to physical and psychological disease and disorder. For our military servicemen and women, it goes without saying that the daily stress they are under can easily develop into post-traumatic stress disorder (PTSD) by the time they return home. Current treatment options for PTSD are counseling and pharmaceuticals. Unfortunately, the pharmaceuticals bring with them an enormous risk for dangerous and deadly side effects. In most cases, both nervine and adaptogenic herbs are able to respond to the symptoms of PTSD without side effects. This paper explores herbal treatment options for PTSD that can replace SSRI medications that support stress reactions within the body, balance the stress response in the body, relieve the symptoms of PTSD, and allow servicemen and women to return to normal lives without dangerous side effects.
Drug-Free Alternatives for Post-Traumatic Stress Disorder (PTSD)
Scientific research has identified stress as a causative factor for many modern day illnesses. When the body is stuck in a ‘fight or flight’ mode, especially following a traumatic incident, the cortisol released through the adrenal glands can cause serious physical damage. Considering the type and amount of traumatic incidents that our servicemen and women are subjected to as they battle terrorism around the world, it is no wonder that so many of them come home with post-traumatic stress disorder (PTSD).
Conditions or presented symptoms of what is now called PTSD dates back to the Civil War when an army surgeon diagnosed soldiers with an ‘irritable heart’ if they were experiencing shortness of breath, dizziness, chest pains, irritability, depression or disturbed sleep patterns (Evenson, 2002). Ever since, times of war have renamed these same symptoms. In World War I, it was known as ‘shell shock’. In World War II and the Korean War, it was ‘battle fatigue’ (Evenson, 2002). In addition to their experiences in ‘theatre’, the soldiers that fought in the Vietnam War had more to contend with once they arrived home. The negativity attached to the conflict left many soldiers ignored and often hated by the general public. Help of any kind was hard to come by so many soldiers turned to alcohol and drugs which presented an even larger spectrum of symptoms. In order for the Veteran’s Administration to provide free treatment to these soldiers, a single classification had to be created. The American Psychiatric Association and a group of veterans joined forces and petitioned Congress. As a result, post-traumatic stress disorder (PTSD) was added to the Diagnostic Statistical Manual of Mental Disorders, Volume 3 (DSM-III) (Evenson, 2002). Further revisions of the DSM stretched the diagnostic criteria for PTSD to approximately 175 combinations of symptoms making some feel as if those that have truly experienced severe trauma were being overlooked for those experiencing everyday traumas (Evenson, 2002).
The failure of the medical community to put together a clear diagnostic definition for PTSD has made it difficult to get an accurate count of the number of veterans who return from service with this disorder. In the PTSD Manual, Parrish (2008) estimated that 20% of veterans that served in Korea and/or Vietnam suffer from PTSD. According to the Department of Veterans Affairs website (2014), approximately 12% of the veterans engaged in Desert Storm and 11% to 20% of soldiers who served in Operation Iraqi Freedom and Operation Enduring Freedom have or will return with PTSD.
Twenty-first century treatments for PTSD include psychiatric counseling along with prescription antidepressant medications or serotonin reuptake inhibitors (SSRI) to relieve the feelings of sorrow, anxiety and worry. Formally, the FDA has only approved Zoloft and Paxil for PTSD along with their black-box label forewarning of an increased risk of suicide for 18-24 year olds, the most common age group for young army recruits (Rosch, 2012). From 2008 to 2012, mental health disorders, including PTSD, were the leading reason for the hospitalization of active-duty servicemen and women with symptoms of nervousness, insomnia, weight gain or loss, and increased feelings of depression and, sadly, suicide rates which increased 80% from 2008-2012, with the numbers exceeding 6,500 per year (Rosch, 2012).
There are a number of herbs that have historically, and through clinical studies, shown to have antidepressant, anti-anxiety, and sleeplessness properties that restore balance and relieve the primary symptoms presented with PTSD without the side effects of pharmaceutical medications. Therefore, it is proposed that replacing SSRI medications, utilized in the treatment of post-traumatic stress disorder, with herbs that support stress reactions within the body, balance the stress response in the body, relieve the symptoms of PTSD, and allow servicemen and women to return to normal lives without dangerous side effects.
Research on this topic was conducted by using the LIRN.net database search for full-text, peer-reviewed articles written in English from 2005 to 2015, Google Scholar, and the Google search engine using key words: Post-Traumatic Stress Disorder; PTSD AND herbs; Herbs for PTSD; PTSD AND Veteran’s Administration; PTSD treatments; herbs for anxiety; adaptogens; PTSD AND Gotu kola; Rhodiola rosea; and stress management. The text book, “Medical Herbalism” by David Hoffmann (2003) was referenced.
The wide range of symptoms that modern medicine is attempting to treat when PTSD is diagnosed makes it truly impossible to single out a set treatment protocol that can be guaranteed to work for each person diagnosed. Symptoms may present as if the individual is reliving the event in the form of a nightmare or a flashback that may occur following a sensory trigger that causes a recall of the event. Attempts to avoid these triggers can place the body in a constant state of stress (VA, 2014). What used to be the fight or flight syndrome has been expanded to the fight, flight or freeze syndrome. The freeze phase is used to describe that same constant state of stress. The body’s reaction to stress involves the release of several hormones which affect the brain, more specifically the hypothalamus and pituitary glands, and the autonomic nervous system. The brain releases hormones into the blood stream; they travel to the adrenal glands, completing the HPA axis. Once there, the release of epinephrine, cortisol, and norepinephrine is triggered (Coltrera, Benson & Casey, 2013). When the system that releases these hormones fails to shut down as the stressful situation winds down, these excess hormones can cause physical damage within the body including high blood pressure and immune system suppression. Psychological effects are presented as depression, anxiety, irritability, nightmares, sleeplessness, flashbacks, angry outbursts, inability to concentrate, suicidal thoughts, drug or alcohol addiction, withdrawing from family, friends or the general public, and hypervigilance (Coltrera, Benson & Casey; Parrish, 2013; 2008). Prior to the Iraqi War, soldiers were sent into battle with a six month supply of pharmaceuticals based on the assumption that the situations they are placed in would require some treatment.
Over 180 phytochemical, clinical and pharmacological studies have been published, since 1960, on the adaptogenic properties of Rhodiola confirming its ‘health-promoting’ qualities. Rhodiola rosea has the ability to increase serotonin in the mid-brain and hypothalamus parts of the brain (Brown, Gerbarg, Romazanov, 2002). A three week, placebo-controlled, double-blind crossover study with 60 participants participated in a water based kava extract. The results of the study determined that aqueous extracts of kava provided noteworthy antidepressant and anti-anxiety action without the safety concerns of kava extracts in an alcohol base (HWHW, 2007).
Sarris, McIntyre and Camfield (2013) conducted a literature review seeking out preclinical and clinical trial data on plant based medicines for anxiety. Fifty-three plants were identified in the 1,525 papers with 21 of the plants having human clinical trial evidence. The clinical trial evidence identified Kava kava, Chamomile, Ginkgo biloba, Skullcap, Milk Thistle, Astragalus, Passionflower, Gotu kola, Rhodiola, Echium, Thryallis and Lemon balm effective with continued use for the treatment of anxiety.
The side effects, complications and contraindications fail to present until the individual has been taking the drug for a period of time, much longer than is required during the clinical trial phase necessary to demonstrate its efficacy and safety. As a result, nearly 50% of PTSD patients quit treatment due to the side effects of these medications (Rosch, 2012). The military has spent in excess of two billion dollars on pharmaceutical medications for the treatment of PTSD since 2001. Despite these frightening statistics, the Veteran’s Administration continues to spend more and more money on dangerous pharmaceuticals.
The use of natural therapies, including herbal formulations, may provide a side effect free alternative to medications. Depression and anxiety, at varying levels, are measured on the Hamilton Depression Scale (HAM-D). Herbs commonly used to treat stress induced depression, potentially through the HPA axis, include American (Panax quinquefolius) and Asian Ginseng (Panax ginseng), Schisandra (Schisandra chinensis), St. John’s wort (Hypericum perforatum), Rosemary (Rosmarinus officinalis) and milky Oat tops (Avena sativa). Additional herbs, specific for the category identified as stagnant depression, which includes PTSD and chronic situational depression include Rosemary (Rosmarinus officinalis), Holy Basil (Ocimum sanctum), and Mimosa bark (Albizzia julibrissin) (Winston, 2014). Severe symptoms with a score over 20 on the HAM-D scale may require the addition of a nervine or adaptogenic herb, including Eleuthero (Eleutherococcus senticosus), Licorice (Glycyrrhiza glabra), St. John’s wort (Hypericum perforatum), Rhodiola (Rhodiola rosea), and/or Ashwagandha (Withania somnifera) (Winston; Guthrie, 2014; 2014). Upwards of 50% of individuals who present with depression will also present with symptoms of anxiety, which is a constant or sudden state of worry, anticipation, or unwarranted inner turmoil. Herbs with an affinity for anxiety include Valerian (Valeriana officinalis), Kava kava (Piper methysticum), St. John’s wort (Hypericum perforatum), milky Oat tops (Avena sativa), Bacopa (Bacopa monnieri), and Gotu kola (Centella asiatica), (Hoffmann; Winston, 2003; 2014). These lists are by no means inclusive, but as such note should be taken on the overlap. Many single herbs have the ability to serve those in various degrees of psychological need.
Conclusions and Recommendations
Nervine herbs have an affinity for the Central Nervous System (CNS) and are available in three primary categories: Nervine Tonics, Nervine Relaxants, and Nervine Stimulants. Lesser categories include hypnotics, antispasmodics, adaptogens, antidepressants and analgesics. The range of symptoms that make up the PTSD disorder confirms the potential for nervine herb formulations as a method of treatment. The second category of herbs that have shown efficacy for the treatment of PTSD are adaptogenic herbs. To be considered an adaptogen, an herb must meet three criteria: 1. It is nontoxic, meaning it is safe for everyone; 2. It builds up the whole body’s resistance to stress, instead of having an affinity for just one body system or organ; 3. These herbs restore balance to bodily functions, no matter where the disruption began. In other words, an adaptogen operates in the body like a tuning fork does for a musical instrument. It helps bring the physical and mental aspects of the body back into homeostasis. An adaptogens influence comes from the synergy of all the constituents within the herb. Therefore, the whole herb, or a whole herb extract, is much more potent and effective than a standardized formula (Guthrie, 2014).
Unlike pharmaceuticals currently prescribed for PTSD, the majority of nervines and adaptogens identified previously are generally regarded as safe (GRAS) when taken according to directions. Unlike pharmaceuticals prescribed based on average statistics, herbal formulas can be individualized to meet each individuals needs. A primary adaptogen-nervine base formula could be created using the following herbs (Winston, 2014):
Eleuthero (Eleutherococcus senticosus); Licorice (Glycyrrhiza glabra) or Wild Yam (Dioscorea villosa); Schisandra (Schisandra chinensis); Milky Oat seed (Avena sativa); Holy Basil (Ocimum sanctum); and Rhodiola (Rhodiola rosea). Eleuthero, licorice, wild yam, schisandra and milky oats are adaptogens with an affinity for the adrenal glands. Holy Basil is anti-anxiety, antidepressant, and neuroprotective, specifically effective for stagnant depression, including PTSD and rhodiola stimulates the release of dopamine and serotonin in the brain. This herb strengthens the central nervous system adapting to both the increase and decrease of nervous system activity.
Additional anti-anxiety herbs may be added to the base formula (Winston, 2014):
Kava (Piper methysticum); Gotu kola (Centella asiatica); Ashwagandha (Withania somnifera). All of these herbs are relaxing nervines and/or adaptogens shown to be effective in the treatment of anxiety, nervous tension, insomnia and mental exhaustion.
For veterans diagnosed with PTSD, alternative treatment options that do not come with a laundry list of side effects should be available. This type of herbal formula can easily be turned into whole herb capsules, extract, tincture, infusion or decoction – whichever type of formula works best for the individual. The restorative capabilities of the herbs in this formula may reduce the number of veterans who are hospitalized after returning from combat. With over 6,500 servicemen and women taking their own lives each year, many as a result of the pharmaceuticals they have been prescribed, imagine how many lives could be saved.
It should be noted that serious, chronic depression can compromise and even threaten an individual’s life to the point of becoming a disability. A qualified medical practitioner should always be consulted when attempting to incorporate an herb or any natural approach into a treatment plan as an alternative to prescribed medications.
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Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Healing Arts Press. Rochester, VT
Parrish, I. S. (2008). Military veterans PTSD reference manual. Published at buybooksontheweb.com, Bryn Mawr, PA
Rosch, P. J. (2012). Drugs for PTSD and other stress related disorders. Health and Stress. 1-13. Retrieved from http://search.proquest.com/docview/1024809238?accountid=158302
Sarris, J., McIntyre, E., & Camfield, D. A. (2013). Plant-based medicines for anxiety disorders, part 2: A review of clinical studies with supporting preclinical evidence. CNS Drugs, 27(4), 301-19. Retrieved from http://search.proquest.com/docview/1465556709?accountid=158302
Symptoms of PTSD (2015) Retrieved from the U.S. Department of Veterans Affairs (VA) website, on the PTSD: National Center for PTSD page at http://www.ptsd.va.gov/public/PTSD-overview/basics/symptoms_of_ptsd.asp
Winston, D. (2014). Differential treatment of depression with botanical and nutritional medicines. Retrieved from: http://www.americanherbalistsguild.com/sites/default/files/ Proceedings/winston_david_-_differ_treat-depression.pdf
Our Guest Blogger this season is Mary M. Ernsberger, M.Ed. is a clinical herbalist, hypnotherapist and author of the forthcoming book, “un-Broken Children – Removing the Label, Restoring Health& Wellness”.
She is the founder of Nature’s Simple Remedies, a company that offers drug-free alternatives to support health and wellness. Her product line is created using certified organic whole herbs and essential oils. Mary utilizes her formal education background in both traditional, complementary and alternative medicine and education, in addition to her more than nine years of practitioner experience, to aid her clients in identifying the most effective and SAFE natural therapies to restore balance to their lives. She lives in Titusville, FL and can be reached by via email at NaturesSimpleRemedies@gmail.com or by phone at 360-525-8533. Call to schedule a FREE 30 minute consultation. Be sure to LIKE her Facebook page at Nature’s Simple Remedies and visit her website athttp://www.NaturesSimpleRemedies.com.