PTSD Treatment: Drug-Free Insights from Dr. Victor Carrión

In a recent Huberman Lab podcast episode, Dr. Andrew Huberman hosted Dr. Victor Carrión, Vice-Chair of Psychiatry and Behavioral Sciences at Stanford School of Medicine, for an illuminating discussion on Post-Traumatic Stress Disorder (PTSD). The conversation shed light on crucial aspects of PTSD, particularly in children and adolescents, while also addressing its impact on adults.

Redefining PTSD: From Disorder to Injury

A significant point raised during the discussion was the proposal to view PTSD as an injury rather than a disorder. Dr. Carrión suggested the term “Post-Traumatic Stress Injury,” emphasising that it represents a dysregulation of the autonomic nervous system rather than an inherent disorder. This perspective shift helps in understanding PTSD as a biological response to trauma that can be treated and healed.

Dr. Carrión emphasised the importance of identifying triggers in PTSD treatment. Key points included:

Triggers are often neutral sensory inputs (colours, sounds, smells).
They become associated with trauma through classical conditioning.
Identifying triggers helps patients understand their responses.
Recognition of triggers can lead to more effective treatment.

Reducing Drug Dependency: Clarifying PTSD and ADHD Symptoms

The discussion reveals a complex relationship between Post-Traumatic Stress Disorder (PTSD) and Attention Deficit Hyperactivity Disorder (ADHD). Dr. Carrión emphasises that while ADHD is a real condition, there’s evidence of both over-medication of children in general and under-medication of those who truly have ADHD. This paradox arises partly from diagnostic challenges and access to proper mental health services.

One key distinction between ADHD and PTSD lies in the pattern of hyperactivity. In children with genuine ADHD, hyperactivity tends to be persistent across different environments and situations. However, in children with PTSD, what might appear as hyperactivity is actually hyperarousal or hypervigilance, which is more sporadic and typically triggered by specific cues that, consciously or unconsciously, remind the body of traumatic experiences.

The attention component also differs between the two conditions. In ADHD, while inattention is a core symptom, children can often focus intently on activities they find engaging, such as video games. This selective attention ability is an important diagnostic consideration. In contrast, attention issues in PTSD may be more related to hypervigilance or dissociation, where the child’s attention is affected by their trauma response rather than an inherent difficulty with attention regulation.

Treatment approaches differ significantly between the two conditions. For ADHD, stimulant medication is often the first-line treatment and can be very effective when the diagnosis is correct. However, for children with PTSD, psychosocial interventions are the primary recommended treatment. Dr. Carrión points out that giving stimulant medication to a child with PTSD but no ADHD not only fails to address the underlying issue but may actually exacerbate the hyperarousal they’re already experiencing.

The discussion also touches on the importance of proper diagnosis. Some children may be sent to doctors with notes suggesting ADHD and requesting stimulant medication, when in fact their symptoms stem from trauma responses. The hypervigilance of PTSD can be misinterpreted as hyperactivity, and trauma-related dissociation might be mistaken for inattentiveness characteristic of ADHD.

It’s worth noting that ADHD and PTSD can coexist in the same individual. In fact, having ADHD might increase vulnerability to developing PTSD, as the attention difficulties associated with ADHD might make it harder for individuals to be fully aware of their environment and potential dangers.

The discussion emphasises the need for careful differential diagnosis and understanding the distinct characteristics of each condition to ensure appropriate treatment. This is particularly crucial given that the wrong treatment approach could potentially worsen symptoms and fail to address the underlying issues affecting the child’s wellbeing and development.

Treatment Approaches

Dr. Carrión discussed various treatment strategies, focusing on his developed approach:

Cue-Centred Therapy (CCT)
- Educational component about trauma and its effects.
- Teaching about classical conditioning and trigger identification.
- Emphasis on self-efficacy and empowerment.
- Demonstrated effectiveness in reducing anxiety, depression, and PTSD symptoms.

Key Treatment Considerations

Addressing multiple traumatic events, not just single incidents.
Developing treatments that can work without parental involvement when necessary.
Using a hybrid, multimodal approach combining various therapeutic techniques.

This insightful discussion between Dr. Huberman and Dr. Carrión illuminates the complex nature of PTSD, particularly in young people. The conversation emphasises that with proper understanding and treatment, recovery from PTSD is possible, especially when intervention occurs early in life. As our understanding of the neurobiological underpinnings of trauma continues to grow, so too does our ability to develop more effective treatments for this challenging condition.