Morphine May Help Traumatic Stress
By BENEDICT CAREY
Published: January 13, 2010
Doctors have long hoped to discover a "morning-after pill" to blunt the often disabling emotional fallout from traumatic experiences. Now it appears that they have had one on hand all along: morphine...In a large study of combat casualties in Iraq, Navy researchers reported Wednesday that prompt treatment with morphine cut in half the chances that troops would develop symptoms of post-traumatic stress later on...The new study, appearing in The New England Journal of Medicine, supports the standard practice in settings like the battlefield and emergency rooms, where morphine is often used readily. But experts say it may have implications for the timing of treatment and for a wider variety of traumas, like those resulting from rape or muggings.
Overall, the NYT article is reasonably good, complete with the necessary disclaimers about how limited the study is. One odd thing about it: Carey's articles usually exhibit a noticeable bias against the use of psychotropic medication. I did not notice any such bias this time. The reason this is notable, is that often the medications he disparages often are drugs that have undergone multiple placebo-controlled, double-blind clinical trials. There have been no such studies on the use of morphine for PTSD.
Indeed, this is an area in which it would be exceptionally difficult to design a really good prospective study. After all, you cannot randomly select people to be traumatized. And it would be difficult to justify randomizing people to receive placebo, if they have been traumatized in such a way that morphine ordinarily would be given.
As it stands, the study really does not have any direct clinical application. (Few single studies do, of course.) One reason it is interesting, is that it provides some comfort that the morphine does not makes things worse for the patient, in terms of the psychological aftermath. The other reason it is interesting, is that it would be really nice to know how this works on a molecular level. That remains highly speculative.
Brain & Behavior
Comments
I do wonder why Carey is less critical of the morphine idea. Perhaps it is because he consideres PTSD so far from common experience, that he is suggesting that a compromise is necessary. I find this a real problem, both in understanding trauma, and in the process of discovering new treatments. At what point is an experience one that should be clouded, blocked, or erased? I am in general a proponent of medication for all types of psychological issues. I also don't judge anyone for trying whatever they can find to hide from the harsh realities of major trauma. It would be a shame though if morphine is considered the best solution in my opinion. It is like drinking vodka to get over stress. In a limited study, I think you will find some benefit. Long term, it can be destructive. If depression, general anxiety disorder and even schizophrenia can be medicated safely, and routinely, certainly PTSD can. The search needs to continue, and if Morphine is the best shot, then that is fine.
Posted by: Matthew Putman | January 18, 2010 11:05 AM