Nov. 10, 2016 -- In a given year, about 8 million people in the U.S. have posttraumatic stress disorder or PTSD. Many will get help by combining talk therapy with medications. But that combination, considered the gold standard for treating the disorder, doesn't work for everyone. Four experts described the most promising emerging treatments currently under study. On their list:

Virtual reality exposure therapy. Using virtual reality is a new twist on a type of treatment called prolonged exposure therapy. The traditional form exposes someone with PTSD over time to things or events they avoid due to trauma associated with them. Some experts say that adding the component of virtual reality may work even better.

A computer simulation can re-create smells, sounds, and images linked with the trauma. After the experience, patients talk about it with their therapist.

"You create a scenario where you help the patient re-create the experience in a controlled environment and address the feelings and thoughts associated with it," says Daniella David, MD, chief of psychiatry at the Miami VA Healthcare System."It helps people process the emotions.”

“It does seem to be more powerful [than exposure therapy alone]," says Spencer Eth, MD, chief of mental health services at the Miami VA.

But a recent report found that although the therapy seems promising, there’s limited evidence for how well it works. And there’s no good study comparing traditional exposure therapy with virtual reality, says Matthew Friedman, MD, PhD, former executive director of the VA National Center for PTSD. Exposure therapy of any type is best supervised by a trained therapist, experts say.

Ketamine. This drug, used as an anesthetic, is being tried as an experimental treatment for depression that has resisted other treatments. It may also help PTSD, says Adriana Feder, MD, associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai. In a study, Feder and colleagues gave ketamine through an IV to people with PTSD. The treatment was linked to fewer PTSD symptoms 24 hours later when compared to another anesthetic medication, midazolam (Versed). But the study was small, with just 41 patients. Feder says the drug can distort users' perceptions of sights and sounds and lead to a detached feeling for a short time.

Prevention. Some experts are trying to head off PTSD before it begins. They may do this by using medications, talk therapy, or both soon after someone experiences the trauma. Scientists are studying a variety of drugs, including the high blood pressure drug propranolol, Friedman says. It can soften the emotional aspects of the memory. The medicine can’t be taken by everyone, including people with low blood pressure.

Mindfulness. Mindfulness-based therapy may quell the anxiety and ''on-edge'' feeling PTSD sufferers have, some experts say. The approach is now widely accepted to help lower stress and anxiety for people without PTSD. It involves meditation practices such as sitting and focusing on your breathing to help you be ''in the moment.”

"What's happened has happened," Friedman says. "You can't make it un-happen. The mindfulness approach acknowledges that and gives you tools so you can look at what happened and process it in a different way."

Other approaches. Some researchers are looking at magnetic resonance therapy or MRT, also known as ''brain zapping." A coil delivers a pulsed, magnetic field to the brain to “retune” it and its reactions. It's not clear how this may help control mood and depression. A small clinical trial of this approach is underway.

Researchers have also studied medical marijuana, but people with PTSD may be at risk for developing a drug abuse problem, including marijuana, Eth says. Another approach looks at resilient people who are not as affected by trauma and what they can teach others, Friedman says.

Half of all people in the U.S. will be exposed to some serious trauma in their lifetime, Friedman says. While most don't develop PTSD, for those who do, it’s crucial they have a variety of treatment choices since experts know there is no single approach that helps everyone.

While these emerging PTSD treatments are promising, they are all still under study, experts say. Only small numbers of patients have been tested, and study findings will need to be duplicated before they become more common.

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Matthew Friedman, MD, PhD, professor of psychiatry and pharmacology/toxicology, Geisel School of Medicine, Dartmouth University; senior advisor and former executive director, VA National Center for PTSD, U.S. Department of Veterans Affairs.

Adriana Feder, MD, associate professor of psychiatry, Icahn School of Medicine, Mount Sinai; associated director for research, Icahn World Trade Center Mental Health Program.

Daniella David, MD, chief of psychiatry, Miami VA; professor of clinical psychiatry, University of Miami.

Spencer Eth, MD, chief of mental health services, Miami VA; professor of psychiatry, University of Miami School of Medicine.

National Center for PTSD.

Canadian Agency for Drugs and Technologies in Health.

JAMA Psychiatry: "Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial."

Journal of Neuropsychiatric Disease and Treatment: Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability."

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