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The current policy to give soldiers who have Post Traumatic Stress Disorder (PTSD) antidepressants and then return them to combat duty did not add up with what I knew about how PTSD affects the brain's neurobiology. The policy of returning troops for multiple tours of duty also raises red flags with regard to the human brain's reaction to continued dangerous and threatening conditions. I have not seen much in the media or on blogs with regard to the scientific studies done on the neurobiology of the brain under conditions of combat. This meant that I would have to do a bit of research and post this information. First, I want to define PTSD, explain some of the areas of the brain that factor in with PTSD, and then discuss what the research on the neurobiology of the brain tells us and how this information conflicts with the ways the soldiers are treated.  Finally, I want to address treatment and what neurobiology is showing what works. I know the current administration frowns on science. In fact; while attending a conference on the brain and neurobiology, many of the presenters nervously joked about using the term "evolution".

Symptoms of PTSD include recurrent intrusive thoughts, recollections of the event, nightmares, flashbacks - reliving the event, dissociation, hallucinations, hyper vigilance - easily startled, on high alert for possible threats, an intense need to avoid any sites, sounds, smells, people who can trigger flashbacks or recollections of the events, feelings of a shortened lifespan, increased irritability, poor concentration, insomnia, and feelings of detachment from others.

So what is going on in the brain to cause all of this?

The Amygdala is part of the limbic system and it plays a part of in regulation of emotions, like fear, and the ability to read facial cues.  It also plays an important role in maintaining memories with regard to emotional events. Studies have shown damage to the Amygdala connected to PTSD.

Douglas Bremer is known for his research on the affects of combat related PTSD on the brain. He has several published studies showing MRI images of about 8- 12% shrinkage to the Hippocampal area.  Cortisol, a stress released hormone  is known to damage the Hippocampus and cause the shrinkage or rather destruction of neurons. The Hippocampus is also part of the limbic system. It helps with conscious memory and establishing new memories (learning). (It is one of the first parts of the brain to be effected by Alzheimer's.) The Hippocampus also works with a part of the brain called the medial prefrontal cortex which helps regulate emotional and fear responses. Damage to the Hippocampus can also contribute to the feelings of unrealness or dissociation.

We believe that dysfunction in these medial prefrontal regions may underlie pathological emotional responses in patients with PTSD. For example, we sometimes see a failure of extinction of fear responses -- a rape victim who was raped in a dark alley will have fear reactions to dark places for years after the original event, even though there is no threat associated with a particular dark place. In a study using combat-related slides and sounds to provoke PTSD symptoms, combat veterans with PTSD had decreased blood flow in the area of the medial prefrontal cortex. Significantly, this did not occur in combat veterans without PTSD. We saw similar results when we compared women with PTSD and a history of childhood sexual abuse to women with a history of abuse but no PTSD.  Bremer

Studies have also found that blood flow to the middle temporal (thought to play a role in auditory processing and language)and left inferior frontal cortex is decreased when combat related PTSD subjects were shown combat related slides meant to trigger PTSD symptoms. The frontal lobes are also called the executive function. It is the area where we "think", the area of judgment - knowing right from wrong, recognizing cause and effect, and where we analyze emotions and regulate them. The frontal lobes are that part of your brain that asks if you are over reacting to a fear stimulus. When this area is impaired, then the fear triggered memories and responses of the Amygdala and Hippocampus overwhelm.

Currently, the military is giving soldiers with PTSD antidepressants and then sending them back out to the very environments that caused the PTSD. They are giving the antidepressants because studies show that the antidepressants help the brain to repair from the damage the traumatic event(s) caused, but it does not stop the flashbacks, intrusive thoughts, etc...  Some soldiers may have had abusive childhoods that have already primed their brains with PTSD triggers. The damage to the brain that is caused by childhood abuse, sexual abuse, or rape is the same as they see in combat related PTSD MRI's. If a soldier has an underlying condition or genetic propensity for say, Bipolar Disorder, the antidepressant could trigger a manic episode. Antidepressants do help in the treatment of PTSD, but they need to be used in conjunction with talk therapy and closely monitored. We would not give a rape victim antidepressant medication then send her back out into a dangerous environment that placed her in jeopardy of being raped again and then expect that she would cope. The policy and treatment of soldiers is insane. These soldiers' are not getting the services in Iraq nor at home to help them recover from the brain damage caused by PTSD.  My question; does PTSD and the damage it does to the brain play a factor in war atrocities?  The people of Iraq are living in a constant environment of PTSD inducing events. Other studies are showing that PTSD slows the learning ability in children.

Treatment of PTSD:
Research has shown that talk therapy helps. When we talk about and try to identify our feelings related memories we are stimulating connections between the frontal lobes and the limbic system. This process takes time, but as one proceeds one is not so overwhelmed by emotional whims caused by the flow of unconscious emotional memories from the Amygdala. Daniel Siegel, MD from the UCLA Center for Culture, Brain, and Development has stated that replicated studies are showing how meditation, no matter what form is practiced, causes the frontal lobes to repair and develop. EMDR has been used for some time now. EMDR involves having the eyes move rapidly back and forth; thereby, replicating REM sleep or some theorize that it stimulates the frontal lobes to be better able to analyze the content coming from the limbic system.
As I have said before, medication does help, but not just by itself. I have treated witnesses to murders who were experiencing extreme PTSD. The medication helped some, especially with improving sleep and having fewer nightmares, but it did not stop the episodes of flashbacks, hypervigalence, dissociation, avoidance, and grief. These symptoms took time to heal. Due to the severity of the issue I do not believe that any short-term therapy is appropriate. PTSD heals on its own schedule; it does not relate to the hurry up and find the most cost effective budget minded solution policymakers look for.  It is important that we see PTSD for what it is. It is not a sign of weakness; it is a neurobiological issue. We need to address and deal with it as such.

Originally posted to hiddengnostic on Sun Jun 04, 2006 at 06:14 PM PDT.

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Comment Preferences

  •  MRI Images (6+ / 0-)

    MRI Comparision of Vets with PTSD, Vets without PTSD and compared to healthy controls. See the area where the Hippocampus has shrunk.

  •  Here is a real good MRI image (5+ / 0-)

    MRI comparing twins, one combat exposed and the other not exposed to combat.

  •  MRI clear image with (5+ / 0-)

    an article by Bremer regarding Hippocampus shrinkageand PTSD

  •  This Is Probably The Best Description I've (7+ / 0-)


    Thanks for spending the time and effort to put this diary together.

  •  Good link for more info (5+ / 0-)

    This article sites some great research. I wish I saw it earlier

  •  Excellent work hiddengnostic. Recommended (9+ / 0-)

    So what you are really saying is that troops with PTSD need to be sent home for long term theraby.  And, further, your research seems to suggest that sending these poor fellows back into combat with only anti-depressents is an abuse that not only leads to more permenent damage to their brains as well as probably creates condiditions likely to increase the probability of breakdowns such as we see in Haditha?

    If so, would an alternative title for you excellent post be "US Military Exploiting Brain Damaged Troops And Jeapordizing Iraqi Civilians?"

    I know that as a scientist all of your training goes against such a "sensationalist" exclaimation.

    But do we not face a moral dilemma here?

    How can we sit by quitely and allow politicians to exclaim support our troops, when in fact, the US militiary is abusing these poor victims of  brain damage.

    As a doctor, is there not a moral obligation to do something more than give an injured soldier a few pills and send them back into theatre combat because the military can not fulfill recruiting quotas?

    I know you are not responsible for this. I am just hoping, perhaps, I could encourage you to make the strongest possible statement you can that is both consisistent with science AND really supportive of our troops.

    One part of your diary which I must reread to make I restate correctly, is that forcing or perhaps even allow combat troops into 2,3, and even 4 consective combat tours of duty places their health in severe jeapordy.

    I just read a tear jerker of an article in Newsweek about the flood of reports of civilian deaths in Iraq, of which, apparently, Haditha is only the tip of the iceberg.

    The implication is that the fundemental responsibility for any war crimes committed in so many "isolated events" is really higher up in the chain of command where the types of decision are being made.  

    The Newsweek article also pointed out that are troops were trained for traditional open battle field all out maximum kill assualt, not intra-city counter-insurgency where it is not clear who are civilians and who are the terrorists.

    The descriptions make it sound as if our entire field forces in Iraq have been placed in the worst possible environment from the point of view of risks of PTSD.

    And that our entire force may be in a collective PTSD like crisis (I mean metaphorically.)

    Excellent work. I hope you can figure out better treatment for these poor soldiers.

    Not even to mention the Iraqi civilians and children, many of whom have lived on the brink of sheer terror for almost three years now.  With no hope of end in site.

    What hope of treatment is there for these folks. Anti-depressents in the water supply?  

    •  We are on the same wave length. (6+ / 0-)

      Not only are our soldiers suffering, but the people around them. Antidepressants are only a band aid and not a good one.
      I would not be at all surprized if we hear of more atrocities and that the ones who were involved were in Iraq more than one time. I think that the Haditha soldiers will use a PTSD defense.
      The soldiers are out in humvies always on the alert for a bomb or being shot at. The atrocity happened right after their friend was killed. Did the soldier(s) in charge have significant frontal lobe impairment that he reacted from the limbic system?

      I wonder if the experience is different in Afganistan.

      I think the DOD is ignoring the research and just went for the band aid. Yes, they do not want to awaken the American public by saying we made a mistake or the word "Draft", they are abusing our kids.
      It makes the phrase "Support the Troops" hollow.

      •  On Second reading I find your article (0+ / 0-)

        already taking the harder line I was trying to encourage you to.

        Your article was so excellent, I got lulled into the impression that you were a brain surgeoun mostly giving us pure science.

        But I see know that you were well ahead of me on the poltical implications.

        Keep up the work fellow traveller.  Tell me how I can help.  Supporting and giving adequate medical attetion to these poor soldiers, many almost children, is the least we can do,

        Anything less, is tantamount to abuse of the mentally ill.  And War crimes against the Iraqis.

  •  PTSD (8+ / 0-)

    Vet to Vet clincs help but cut by Bush in 2007 budget.1 out of Four right now in Iraq are suffering from PTSD. Prozac and others are being handed out to the troops.San Digeo .com had DOD statement claiming we have to see how troops react on meds.VVA statement stop experiment ing on our Troops. Not one Major News Outlet has covered the story.I have been printed in the Suntimes and other newspapers in IL and have been blasted by the right saying I do not support the troops.Thet Even tried and failed to swift boat me.The one thing and this is from a combat vet anything that sows your reaction time down will get you killed or wounded. This also explains the suicide rate in Iraq.Now is the big story about those Marines they were on meds.That is no excuse but that does give us ammo to remove Rumsfeld once and for all.In your search engine enter Troops with Mental Problem being returned to Iraq.Or go to va and use his search engine on the site.Write, call or whatever you have to do get these sick troops out of Iraq hell get them all out now

    •  Senator Joe Biden has reiterated his calls for (6+ / 0-)

      Secretary of Defense Donald Rumsfeld to resign.

      It is clear to me that his arrogance, incompetence, and failed neocon philosphy has create an unmitigated disastor for all parties here.

      I was already of the opinion that he should be charged with war crimes.

      But, this is now becoming rediculous.

      Rumsfeld must resign,be fired, or impeached.  Let's start proceeding now House Judiciary Committee.

      And where is the oversight of the Armed Services Committee.  We need to get this article to Chairmen John Warner and say "oversee, damn-it!"

  •  Spiritual component (7+ / 0-)
    My own theory on PTSD is that these soldiers are suffering spiritually.

    They need spiritual healing in addition to psychological healing.  And many of our spiritual leaders - and communities - are failing them.

  •  Relevant In These Times Article-- (4+ / 0-)

    "Think of Iraq as a military base with a very large oil reserve underneath.... You can't ask for better than that." Fadel Gheit

    by Superpole on Sun Jun 04, 2006 at 07:15:13 PM PDT

    •  Thank you for the excellent link (4+ / 0-)

      So they are giving out Xanax too? This is a highly addictive drug. It is a tranquilizer and will do more to take the foot off the break rather than help it stay on. It is often given for anxiety on a tempoary bases.

      The other info in the article is that the Iraqi people are able to get the drugs from the store? Who is supervising the administration of the drugs?

      And then the BIG question:
      Is BIG Pharma making a big profit off of the misery.
      How are the drugs getting there, who has the contracts, just wondering?

      •  Good Questions - All (0+ / 0-)

        File under:

        "Better war thru drugs".


        it seems a number of connected corporations are in on the warmongering/profiteering.

        I have to wonder how many poor souls will end up in prison with the other "drug offenders" should they go off of their PTSD meds when they get back?

        "Think of Iraq as a military base with a very large oil reserve underneath.... You can't ask for better than that." Fadel Gheit

        by Superpole on Mon Jun 05, 2006 at 10:56:39 AM PDT

        [ Parent ]

      •  Here's another article re: troops & drugs: (0+ / 0-)

        ITALY: Steroids Headed for Troops in Iraq Seized  : "The popularity of steroid abuse has long been discussed as American troops and contractors in Iraq work out in gyms set up in bases and even in the mirrored halls of one of Saddam Hussein's former palaces."

        Could there be some 'roid rage' involved here?

        Excellent diary and links. I find your comment about video games and lack of 'executive function' the most chilling. Aren't video games used by the military for training?

  •  excellent excellent work (4+ / 0-)

    thank you. i'd heard a bit about some of this info here and there, but it's  extremely helpful to have it all in one place.

    o/t, but somewhat related --- there has been some wonderful work linking PTSD acquired early in life with alcoholism and diabetes in American Indian communities. The work doesn't overtly state, but does strongly suggest the damage done by PTSD goes far beyond neurology and impacts every system of the body. I'd expect the same might be true for veterans w/ PTSD?

    •  People will use food and alcohol (5+ / 0-)

      to self medicate. This is also related to Bipolar disorder - about 60% of folks with Bipolar also abuse a substance.

      The reason is this. Alcohol breaks down to sugar as a bi-product. High Carb intake also a sugar. When the brain is serotonin low one will feel irritable. PTSD also has a low serotonin issue - hence Prozac or Zoloft they work on Serotonin.

      So when you take in sugar you release insulin, insulin has the effect of taking out many of the protiens floating around in the blood stream in the brain except for a few. One that insulin leaves in the brain is the protien precursor for serotonin - Tryptophan. So Tryptophan has fewer proteins to compete with to get across the blood brain barrior and more serotonin is produced.

      Turkey and dairy products are rich in Tryptophan.

  •  Outstanding hiddengnostic. Well researched and (6+ / 0-)

    well written. And fraught with implications.  Perhaps, the best written diary of the day.  Congratulations.

    And I agree. Rumsfeld must go!  We have to make it clear that the highest levels of leadership also must be held accountable for these kinds of judgement errors and unethical conduct.

    Helping to bring justice back to the White House, one indictment at a time.

    by HoundDog on Sun Jun 04, 2006 at 07:21:34 PM PDT

    •  Here is something I wonder about (5+ / 0-)

      While I was at this conference with many noted researchers in the field, they all were nervous to say anything that could be critical of the current Administration. Fear of having their research funding taken? I wondered. It was odd. It seemed that they were really watching what they said in case the secret police were there.

      •  Of all that you have written that is scariest. (1+ / 0-)
        Recommended by:
        73rd virgin

        My blood pressure just went up and my heart skipped a beat.  I'm gobstruck.

        Jesus - WTF

        "Time to clean out the crap in Congress" - Jesus (D) Nazareth

        by llbear on Sun Jun 04, 2006 at 09:01:26 PM PDT

        [ Parent ]

        •  And I was so taken by this last comment (2+ / 0-)
          Recommended by:
          Margot, 73rd virgin

          I forgot to thank you for the diary.  Awesome work.  I want to re-read it several times.

          "Time to clean out the crap in Congress" - Jesus (D) Nazareth

          by llbear on Sun Jun 04, 2006 at 09:02:41 PM PDT

          [ Parent ]

          •  Some folks mentioned that they ran (1+ / 0-)
            Recommended by:

            some treatment programs that got funding from the faith based charity program Bush started, hence; the careful words. Also Bremer is well known, how come we have not heard more from him in the media or others like him to explain PTSD. The information is easy to find, it is on the net. One can listen to Siegel lecture on line.

            •  There is a scandal about Federal Funding being (0+ / 0-)

              allocated on the basis of support for the Administration just recently. Last month, I think the HUD director or at least one significant Federal Funding organization was directly quoted as asking why he should allocate money to opponents.

              This was in a case, the funding was supposed to be allocated only on merit.  I never heard what happened.

              But even more pressure is applied on scientist by lobbyists for the chemical, pharmeceutical, and other industries who make sure scientist studying in their areas know a heavy price will be paid if they "discover" anti-industry findings.  Even to the points that students graduating from certain departments could be penalized in future employment opportunities.

              So the perceived threat of funding loss may be much higher than the actual risk.  But it that inimidates scientist not to even set up experiments that may be seen as unhelpful to big funders of the universities, the lobbyists acheive their desired results.

              Very sad.

              Helping to bring justice back to the White House, one indictment at a time.

              by HoundDog on Tue Jun 06, 2006 at 10:12:58 AM PDT

              [ Parent ]

      •  Well... (0+ / 0-)

        They were probably watched, or at least their words were reported on.
        That's the M.O. of this administration.  Scientists report honestly?  Ka-pow!

        War is not an adventure. It is a disease. It is like typhus. - Antoine De Saint-Exupery

        by Margot on Sun Jun 04, 2006 at 10:45:51 PM PDT

        [ Parent ]

  •  Thanks for this post (4+ / 0-)

    I sent this page to the people in Washington I know its a issue that need to come to the light of day

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