Transcranial photobiomodulation as a novel neuromodulation strategy in severe posttraumatic stress disorder: a case report and clinical outcomes

Introduction: Transcranial Photobiomodulation(tPBM) is an emerging non-invasive neuromodulation therapy that delivers red or near-infrared light (600–1200 nm) to the brain [1,2,3]. Its primary mechanism involves stimulation of mitochondrial cytochrome c oxidase, which increases adenosine triphosphate(ATP) production and enhances cellular energy metabolism [1,4,5]. Additionally, tPBM modulates oxidative stress, reduces neuroinflammation, promotes neurogenesis and synaptogenesis, and increases regional cerebral blood flow [3,4].

Clinically, tPBM has shown promise in treating a wide spectrum of conditions, including Major Depressive Disorder, Traumatic Brain Injury, Alzheimer’s, and Parkinson’s disease [1,3,4,5]. Recent preclinical and clinical findings specifically highlight its potential for Post-Traumatic Stress Disorder(PTSD). In rodent models, tPBM has been shown to prevent contextual amnesia and trauma-induced comorbidities such as anxiety and cognitive deficits [1,5]. Human case studies further indicate that tPBM, as a standalone or augmentative strategy, can significantly reduce PTSD symptom severity and improve neurocognitive performance [4]. As a safe and well-tolerated intervention, tPBM represents a novel therapeutic approach for trauma-related disorders [2,3,4].

Clinical Case: A 17-year-old female with a history of childhood trauma presented with severe PTSD, recurrent suicidal behaviors, self-harm, anhedonia, and attentional deficits. Psychiatric history included multiple suicide attempts (ingestion, hanging, insulin overdose, high-risk behaviors) and partial response to prior psychotherapy. Past medical history was notable for a ruptured brain arteriovenous malformation in 2018, Gilbert syndrome, and familial bipolar disorder. Genetic testing revealed COMT AA genotype, suggesting dopaminergic overactivity and predisposition to depression. Initial psychometric evaluation showed high scores on Childhood Trauma Questionnaire (96), Beck Anxiety Inventory (32), Beck Depression Inventory (32), and suicidal ideation (7).

Over the past six months prior to admission, the patient had struggled with severe emotional dysregulation, frequent crying episodes, social withdrawal, impaired daily functioning, and difficulty maintaining personal hygiene. She exhibited impulsive decision-making, especially under stress, and demonstrated low motivation for school or social activities, further complicating her care and risk management.

The patient had been on pharmacotherapy (Escitalopram and Melatonin) for six months prior to admission, with limited benefit. Upon inpatient admission, intensive psychiatric care included medication optimization (Bupropion, Gabapentin, Aripiprazole, Trazodone), structured psychotherapy, neurofeedback, and tPBM sessions targeting PTSD symptoms. With 80 sessions of tPBM performed daily, significant clinical improvements were observed: depressive and anxiety symptoms markedly decreased, suicidal ideation resolved, and maladaptive cognitive patterns became more flexible. Weekly scale assessments documented sustained reductions in Beck Anxiety and Depression scores (anxiety 32→1, depression 32→2) and elimination of self-harm behaviors.

Conslusion: In conclusion, this case demonstrates the significant therapeutic potential of tPBM for severe, treatment-resistant PTSD and recurrent suicidality in adolescents [1,4]. The patient’s remarkable recovery, marked by a near-complete resolution of anxiety and depression scores, aligns with preclinical evidence suggesting that tPBM restores neuronal bioenergetics by increasing ATP production and modulating neuroinflammation [3,5]. By potentially targeting hippocampal and prefrontal pathways, tPBM may facilitate fear extinction and improve cognitive flexibility, addressing core neurobiological deficits associated with trauma [1,5]. As a safe and well-tolerated intervention, tPBM offers a promising adjunctive strategy for high-risk psychiatric populations [2,3]. Further randomized controlled trials are essential to validate these clinical benefits and optimize treatment parameters.

References

1. Li, Y., Dong, Y., Yang, L., Tucker, L., Zong, X., Brann, D., … & Zhang, Q. (2021). Photobiomodulation prevents PTSD-like memory impairments in rats. Molecular Psychiatry, 26(11), 6666-6679.
2. Askalsky, Paula, and Dan V. Iosifescu. “Transcranial photobiomodulation for the management of depression: current perspectives.” Neuropsychiatric disease and treatment (2019): 3255-3272.
3. Cho, Y., Tural, U., & Iosifescu, D. V. (2023). Efficacy of transcranial photobiomodulation on depressive symptoms: A meta-analysis. Photobiomodulation, Photomedicine, and Laser Surgery, 41(9), 460-466.
4. Mahajan, S., Bodahanapati, A., Katta, A., Aydemir, E., Mendoza, A., Vigilia, C., … & Sunder, K. (2025). Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS®) Coupled with Transcranial Photobiomodulation (tPBM) For Co-Occurring Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD). Acta scientific neurology, 8(3), 20.
5. Li, Y., Dong, Y., Yang, L., Tucker, L., Yang, B., Zong, X., … & Zhang, Q. (2021). Transcranial photobiomodulation prevents PTSD-like comorbidities in rats experiencing underwater trauma. Translational psychiatry, 11(1), 270.