National Post (National Edition)
CAN BIG DATA HELP TREAT PTSD?
As a Canadian army medic, Sergeant Alannah Gilmore was wired to react, to rush toward danger and put broken soldiers back together again. But it was Gilmore who was falling apart after returning home from her tour of Afghanistan in 2007. She was angry, confrontational, high and low and anxious, especially at night, when her mind would reel from one disaster scenario to the next — a plane crash, a terrorist attack, an earthquake, an explosion — robbing of her sleep.
“That is what my brain thinks about,” Gilmore says, chuckling softly. “What is my worst-case scenario, and how do I deal with it? “I felt haunted.” Gilmore’s struggles were magnified as the spouse of a disabled veteran. What if their Ottawa home were targeted? What then? All around were stresses, pressure points and post-deployment red tape to wade through that led to a diagnosis of PTSD.
Army doctors prescribed her antidepressants. One drug made Gilmore feel like a zombie. So her physician tried another. It made her hyper-aggressive. A third medication gave her twitchy legs, and a fourth nasal swelling. There were other drugs, but no real relief.
Gilmore’s experience with medication is not uncommon among post-traumatic stress disorder sufferers. Gen. Romeo Dallaire has lived with the illness for 20 years, and describes feeling like a “chemical experimental station.” About five per cent of Canada’s 65,000-plus full-time soldiers have PTSD. Fourteen active-duty personnel killed themselves in 2015, according to a Canadian Forces report released Nov. 23. Almost 65 per cent of that number were suffering from a mental-health injury or disorder, while almost 80 per cent had sought some form of treatment. It is an ongoing problem in care that the Forces is hoping to remedy by enlisting an oldschool medical technology.
Electroencephalograms or EEGs, have been around since the 1920s. They record electrical activity in the brain through electrodes attached to the patient’s skull.
EEGs are commonly used to diagnose epilepsy. In psychiatry, they have traditionally been applied to rule out, for example, a brain tumour being responsible for a patient’s personality change.
Colonel Rakesh Jetly is the army’s senior psychiatrist. Three years ago, he learned of an American study at the Walter Reed National Military Medical Center in Bethesda, Md. Soldiers and veterans with PTSD, anxiety or depression were asked to submit to an EEG. Their scans were uploaded to a database containing about 10,000 scans of patients who had responded positively to drug therapy. Advanced software developed by MYnd Analytics, a California-based “predictive analytics” company, searched for matches between the scans. Doctors then received a predictive guide as to what medication was best-suited to their patient — based on the brain’s electrical signature. Each new scan was added to the database, further fine-tuning its accuracy.
While the patient sample size at Walter Reed was small, involving about 150 subjects, results were encouraging. Test subjects reported being less depressed, had fewer thoughts of suicide and felt more engaged in treatment. Similar trials yielded similar results, and they were enough to convince the Canadian military to launch its own study — at the Canadian Forces Health Centre and The Royal Ottawa Operational Stress Injury Clinic — regarding the novel application of the EEG.
“It is a big data idea combining a classic test — the EEG — with a modern concept,” Col. Jetly says. “This is how Google works, it looks for trends.”
Psychiatry has a mystical quality. Blood tests can’t detect mental illness. Doctors interview patients. Patients fill out questionnaires and self-report. Doctors form a diagnosis and treat the illness based on experience, instinct and guidelines. It is trial and error. The EEG, in theory, would add a diagnostic tool to the mix — rooted in the patient’s physiology. In psychiatry, that is a revolutionary development.
“It takes out the whole notion that you treat by symptoms,” says Verner Knott, the principal investigator on the study at the Royal Ottawa, which is seeking 150 participants.
“Symptoms are very subjective. You never really know what medication fits what patients, and so this would take all that guesswork out of it.”
And that is a good thing, since studies show that the efficacy of anti-depressants diminishes with each new drug a patient tries. The longer a patient’s PTSD goes untreated, the greater the likelihood of it becoming a chronic illness.
“In psychiatry, we struggle more,” says Jakov Shlik, a psychiatrist at the Royal Ottawa. “The reality is that 30 to 50 per cent of patients with PTSD or depression never get any better.”
Almost a decade after returning from Afghanistan, Alannah Gilmore can divide her life into “good days and bad.”
She is in a better place mentally than she has been for years, but her medication — and underlying illness — still leave her feeling like about 50 per cent of the elite army medic that she once was.
“The only thing I am consistent at is being inconsistent,” she says, laughing.
Gilmore left the military in 2015 and now advocates for veterans and their families. Mostly, she focuses on getting better, and being a good mom to her two daughters. She doesn’t know if she will join the EEG study, but plans on asking her doctor more about it.
“Had we figured this out for me years earlier maybe there would have been a management system in place that could have kept me in the military,” she says.