Does Hyperbaric Oxygen (HBO) therapy improve Post-Traumatic Stress Disorder (PTSD)?

Hyperbaric Oxygen Therapy for Post-Traumatic Stress Disorder

Hyperbaric oxygen therapy (HBOT) is effective for treating post-traumatic stress disorder (PTSD), with recent randomized controlled trial evidence showing significant symptom improvement compared to sham treatment. 1

Evidence for HBOT in PTSD

• A 2024 randomized, sham-controlled clinical trial demonstrated that veterans with combat-associated PTSD who received 60 daily HBOT sessions (100% oxygen at 2 atmospheres absolute for 90 minutes) showed significant decreases in PTSD symptoms as measured by CAPS-5 scores, while the sham group experienced worsening symptoms 1

• The same study showed improvements in depression scores and enhanced functional connectivity in key brain networks (default-mode network, central-executive network, salience network) as demonstrated by resting-state functional MRI 1

• Earlier research in 2019 showed that HBOT restored fear extinction retrieval ability and reduced conditioned anxiety in an animal model of PTSD, while also normalizing neurochemical abnormalities including monoamine levels and corticosterone profiles 2

• A 2012 study of military subjects with both post-concussion syndrome and PTSD found that 40 sessions of HBOT at 1.5 ATA for 60 minutes resulted in significant improvements in PTSD symptoms, cognitive function, and quality of life measurements 3

Mechanism of Action in PTSD

• HBOT appears to work in PTSD by:
  • Reducing cerebral oxidative stress and inflammation 4
  • Decreasing vasogenic edema 4
  • Preventing hippocampal neuronal apoptosis 4
  • Restoring monoaminergic function in the infralimbic cortex 2
  • Normalizing hypothalamus-pituitary-adrenal axis activity 2
  • Enhancing functional connectivity in key brain networks involved in PTSD 1

Treatment Protocol Considerations

• The most recent and highest quality evidence supports using:

  • 60 daily sessions of 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes with 5-minute air breaks every 20 minutes 1
  • Alternative protocols showing benefit include 40 sessions at 1.5 ATA for 60 minutes 3

• Treatment response appears to be durable, with benefits maintained at follow-up assessment 1

Safety and Adverse Effects

• HBOT is generally well-tolerated but potential adverse effects include:
  • Middle ear barotrauma (most common) 3
  • Transient symptom deterioration 3
  • Reversible bronchospasm (rare) 3

Practical Application

• HBOT should be considered as a treatment option for patients with PTSD who:

  • Have not responded adequately to first-line treatments 1
  • Do not have contraindications to HBOT (such as untreated pneumothorax, certain chemotherapies, or claustrophobia) 1

• While HBOT has been primarily studied in combat-related PTSD, the neurobiological mechanisms suggest potential benefit for PTSD from other causes as well 2, 4

• The treatment requires specialized equipment and trained personnel, so availability may be limited to certain medical centers 1

Comparison to Other Treatments

• HBOT offers a physiological approach to PTSD treatment that differs from conventional psychotherapy and pharmacotherapy options 1

• The most recent evidence suggests HBOT may be particularly valuable for treatment-resistant cases, though direct comparative studies with established PTSD treatments are still needed 1