Researchers at Tel Aviv University (TAU) and the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center have demonstrated that hyperbaric oxygen therapy (HBOT) improves the condition of PTSD sufferers who have not responded to psychotherapy or psychiatric medications.

The researchers say that their unique therapeutic protocol affects the biological brain “wound” associated with PTSD and effectively reduces symptoms such as flashbacks, hypervigilance, and irritability. They believe that their findings give new hope to millions of PTSD sufferers and their families all over the world.

The study was led by Professor Shai Efrati and Dr. Keren Doenyas-Barak from the Faculty of Medical and Health Sciences at TAU and the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center. The paper was published on November 10, 2024, in The Journal of Clinical Psychiatry.

“Due to our unfortunate circumstances, Israel has become a global leader in the field of PTSD,” Professor Efrati says. “Before the Hamas attack on Oct. 7, 2023, approximately 6,000 IDF veterans had been recognized as PTSD sufferers, with many others, both soldiers and citizens, not yet acknowledged by the authorities. Following October 7 and the ensuing war, these numbers have risen sharply. Tens of thousands of soldiers, and much larger numbers of civilians, are likely to be diagnosed with PTSD. At present we treat hundreds of PTSD sufferers every day, aiming to reach one thousand patients per year.”

“In many cases, PTSD is resistant to psychotherapy and common psychiatric medications,” Dr. Doenyas-Barak adds. “Past studies on therapy-resistant sufferers have found changes in the structure and function of brain tissues, or a ‘biological wound’ that explains such treatment resistance. In our study we wanted to determine whether hyperbaric therapy can help these patients.”

The study, which began in 2019 and ended in the summer of 2023, included 98 male IDF veterans diagnosed with combat-associated PTSD, who had not responded to either psychotherapy or psychiatric medications. Participants were divided into two groups: one group received HBOT treatment, breathing pure high-pressure oxygen, while the other went through the same procedure, but received a placebo treatment, breathing regular air. Twenty-eight members of each group completed the process and the following evaluation.

“The HBOT was administered in accordance with a unique treatment protocol developed at our Center,” says Dr. Doenyas-Barak. “Every patient is given a series of 60 two-hour treatments in our hyperbaric chamber, during which they are exposed to pure 100% oxygen at a pressure of 2 atmospheres (twice the normal air pressure at sea level). Our protocol specifies alternately breathing oxygen and regular air: every 20 minutes the patient removes the oxygen mask and breathes regular air for five minutes. The drop in oxygen level, at the tissue level, activates healing processes and thus enhances the therapeutic effect.”

The results were encouraging, with improvements observed both at the clinical level and in fMRI imaging. The group that received hyperbaric therapy showed improved connectivity in brain networks alongside a decline in all typical PTSD symptoms. In the placebo group, on the other hand, no change was observed in either the brain or clinical symptoms.

“Our study demonstrated that HBOT induces biological healing in the brain of PTSD sufferers,” Professor Efrati concludes. “Curing the biological wound also impacts clinical symptoms. We believe that HBOT, based on the special protocol we have developed, can bring relief to numerous PTSD sufferers worldwide, allowing them to resume a normative life in their community and family.”

Israel’s Ministry of Defense funds HBOT for veterans who need it.

Other contributors to the study include Dr. Ilan Kutz, Gabriela Levi, Dr. Erez Lang, Dr. Amir Asulin, Dr. Amir Hadanny, and Dr. Ilia Beberashvili from the Shamir Medical Center, and Dr. Kristoffer Aberg and Dr. Avi Mayo from the Weizmann Institute.