AUTHOR=Andrews Susan R. , Harch Paul G. 

TITLE=Systematic review and dosage analysis: hyperbaric oxygen therapy efficacy in the treatment of posttraumatic stress disorder

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1360311

DOI=10.3389/fneur.2024.1360311

ISSN=1664-2295

ABSTRACT=Background:  Posttraumatic Stress Disorder (PTSD) is a frequently comorbid diagnosis (37%) with mild Traumatic Brain Injury (mTBI) Persistent Postconcussion Syndrome (PPCS) in military veterans. Studies of hyperbaric oxygen therapy (HBOT) treatment of mTBI PPCS in military subjects revealed simultaneous improvement of PTSD and PTSD symptoms that have been replicated in civilian PTSD patients, suggesting that HBOT may be an effective treatment for PTSD. This is a systematic review and dosage analysis of the evidence of HBOT treatment of patients with PTSD symptoms.
Methods:  PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from September 18 to November 23, 2023, for all adult clinical studies published in English on HBOT and PTSD. Randomized trials and studies with symptomatic outcomes were selected for final analysis. Studies and outcomes were analyzed according to the total dose of oxygen on immediate post-treatment symptom outcomes in HBOT-treated versus control groups.  
Results:  Eight studies were included, all with < 75 subjects/study, total 393 subjects: seven randomized trials (four with true control groups, 3 with comparative dose groups) and one imaging case-controlled study.  Whether analyzed by oxygen, pressure, or composite oxygen and pressure dose of hyperbaric therapy statistically significant within and between group symptomatic improvements with or without imaging changes, as well as Reliable Change or Clinically Significant changes were achieved for patients treated with 40-60 HBOTS over a wide range of pressures from 1.3 to 2.0 ATA.  
Discussion:  In multiple randomized and randomized controlled clinical trials HBOT over a pressure range from 1.3 to 2.4 ATA demonstrated either statistically significant symptomatic improvements, Reliable Changes, or Clinically Significant Changes in patients with PTSD symptoms or PTSD.  The imaging findings and hyperbaric oxygen therapy effects indicate that PTSD can no longer be considered strictly a psychiatric disease.