Hyperbaric oxygen- a two part treatment providing effective outcomes

Hyperbaric oxygen- a two part treatment providing effective outcomes

The article below ,while reporting an  effective treatment for PTSD, misleads the reader in the by selection of its title.

Hyperbaric oxygen treatment is a two part treatment in which the professional administering the treatment manipulates both the fraction of inspired oxygen and the atmospheric pressure to establish a new normal.

Breathing 21% oxygen at a sea level pressure results a dose of oxygen of 159.6 mmHg. By increasing the pressure to twice the atmospheric pressure the dose of oxygen becomes 319.2 mmHg, a new “normal”. If the FiO2 is brought from 21% to 100% oxygen resulting in a dose of  1520 mmHg. In the procedure described by Dr Mohta as  the Hyperoxic-Hypoxic, Dr. Efrati applies a series of manipulations in which the FiO2 is changed from 100% to 21% while maintaining the atmospheric pressure at twice the normal. This  cell signaling manipulation  exposes the patient to a “relative hypoxia” without exposing the patient to the harmful effects of true hypoxia.

The latest treatment for PTSD deprives patients of oxygen—and it actually works

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz

| Published January 3, 2025

Industry Buzz

• “HBOT’s mechanisms of action are rooted in its ability to induce the hyperoxic-hypoxic paradox. The fluctuating oxygen levels appear to trigger angiogenesis, mitochondrial repair, and stem cell activation, processes that are essential for neuronal recovery and improved synaptic function.” — Sangeeta Hatila, MBBS, MD
• “For the first time even in humans, we can see generation of new neurons, generation of new blood vessels in the brain. And this is mind-blowing,” — Shai Efrati, MD, Sagol Center for Hyperbaric Medicine and Research

·       PTSD treatment has long been a challenging frontier in mental health, with many conventional therapies yielding mixed outcomes. Emerging evidence now points to hyperbaric oxygen therapy (HBOT) as a potential game-changer, offering new hope for patients struggling with this condition.

Limitations of currently available treatments

·       Board-certified psychiatrist Sangeeta Hatila, MBBS, MD, says, “PTSD treatments, even the most recommended ones like CBT, cognitive processing therapy (CPT), prolonged exposure, or medications like sertraline and paroxetine, often have mixed results, especially over the long term.”

·       The fact is, nearly half of PTSD cases fail to respond to these conventional approaches.[1] “We need therapies that deliver more consistent results and better outcomes for patients across the board,” Dr. Hatila adds.

·       So, could HBOT be the reliable solution we’ve been searching for?

What is HBOT?

HBOT is a proven treatment for decompression sickness, chronic wounds, and respiratory disorders, with growing use in regenerative medicine and, now, even neurology and psychiatry. It involves exposing patients to 100% oxygen within a pressurized chamber, which increases oxygen bioavailability in tissues.[2]

HBOT’s mechanisms of action are rooted in its ability to induce the hyperoxic-hypoxic paradox,” explains Dr. Hatila. “The fluctuating oxygen levels appear to trigger angiogenesis, mitochondrial repair, and stem cell activation, processes that are essential for neuronal recovery and improved synaptic function.”

Insights from a leading research center

At the Sagol Center for Hyperbaric Medicine and Research in Israel, HBOT is being used to treat PTSD in military veterans and survivors of recent trauma, including the October 7th Nova Music Festival attack. This facility, the largest hyperbaric treatment center globally, has treated over 650 trauma survivors in recent months.

Shai Efrati, MD, who runs the Center, explains that HBOT can elevate tissue oxygenation levels to as much as 16 times the normal physiological range. When the oxygen mask is removed, the body interprets the decline back to normal levels as hypoxia. “That causes the body to trigger the stem cells, and for the first time even in humans, we can see generation of new neurons, generation of new blood vessels in the brain. And this is mind-blowing,” explained Dr. Efrati to CBS News.[3]

Ongoing research

The Sagol Center has also recently published compelling findings from multiple studies on veterans with PTSD. In the first study, they investigated the efficacy of HBOT in veterans diagnosed with combat-associated PTSD who had no history of traumatic brain injury.[4]

Sixty participants were divided into HBOT and placebo groups. Over 3 months, the HBOT group underwent 60 sessions, with participants receiving 90-minute exposures to 100% oxygen at 2 atmospheres absolute, including 5-minute air breaks every 20 minutes .

Pre- and post-treatment evaluations were conducted using resting-state functional MRI (rsfMRI). The results were impressive; consider the following:

·       68% in the HBOT group exhibited at least a 30% reduction in PTSD symptoms, compared to just 4% in the placebo group at the end of the treatment.

·       By the end of treatment, complete remission was achieved in 25% of patients, increasing to 39% at the 3-month follow-up after treatment completion—an outcome not observed in anyone from the control group.

·       HBOT group experienced self-reported improvement in anxiety and stress alongside improvement in depressive symptoms.

·       rsfMRI of this group demonstrated improved functional connectivity in the default mode network and better communication between the thalamus and the frontoparietal network.

What impresses me the most is the improvement observed in the default mode network,” Dr. Hatila tells MDLinx about the study. “This is a group of brain regions (including the medial prefrontal cortex, posterior cingulate cortex, and inferior parietal lobule) that are most active when a person is not focused on a task.” She calls it the brain’s “background mode,” running during activities like daydreaming, recalling memories, or thinking about the future.

Another longitudinal follow-up study from the Sagol Center found that the benefits of HBOT in PTSD remission persisted for at least 2 years, surpassing outcomes seen with traditional treatments.[5]

“Based on these findings, I believe HBOT might be somehow recalibrating the disturbed neural pathways, which can restore the brain’s ability to manage stress and process trauma both short term and long term,” notes Dr. Hatila.

Dr. Hatila cautions, however, that HBOT should only be administered in medically supervised settings adhering to standardized protocols. Patients should stay wary of unregulated or non-certified centers, as variations in pressure and oxygen concentration could result in otalgia, persistent headaches, barotrauma, pulmonary oxygen toxicity, and even seizures triggered by CNS oxygen toxicity.

What this means for you

HBOT could serve as a novel intervention for treatment-resistant PTSD, particularly in a population that often experiences limited success with standard approaches, like veterans. In the interim, physicians should remain cautious and ensure that any HBOT referrals are directed to certified facilities that adhere to evidence-based protocols.

HBOT has been shown to be a novel intervention for treatment-resistant PTSD, particularly in a population that often experiences limited success with standard approaches, like veterans. Despite providing consistent results, repeated studies over the last nine that have shown HBOT to be associated with significant improvements in post-concussion symptoms and secondary outcomes, including PTSD (which most participants had), depression, sleep quality, satisfaction with life, and physical, cognitive, and mental health functioning. Stop the misrepresentation.