People exposed to a catastrophic event can have psychological changes. Seeing a bloody car wreck or a shooting, industrial accidents, severe abuse by a caretaker and, of course, war can leave a person with an image of the event that reoccurs in nightmares and at odd times during the day. Victims may avoid anything that remotely reminds them of the event, and there can be general symptoms of anxiety or depression.
Post-traumatic stress disorder (PTSD) is a specific type of anxiety disorder that occurs after a traumatic event or a situation that which the victim under extreme stress for a long period of time. Symptoms may include:
- increased pulse and respiratory rate
- muscle tension
- feelings of fear or worry
- stomach upset
- intrusive thoughts of the event replaying
- sleep problems
- flashbacks of the event.
There are a number of treatments for PTSD, and while cognitive behavioral therapy is usually part of the rehabilitation process, medications are often used in conjunction for moderate to severe cases. Medication can offer quick relief from symptoms that interfere with functionality before the deep-seated issues can be resolved with talk therapy.
Medications for PTSD
There are several types of drugs prescribed for PTSD, most notably those used for anxiety and antidepressants. There are several classes of drugs used for PTSD, including benzodiazipines, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). Most of these affect serotonin, which is a neurotransmitter that produces feelings of well-being and contentment.
Serotonin reuptake inhibitors (SSRIs) are the preferred medication for PTSD. There are two of these drugs approved by the FDA for the treatment of PTSD, they are paroxetine (Paxil) and sertraline (Zoloft).
Off-Label Medications Considered for PTSD
- Venlafaxine (Effexor) is a serotonin reuptake inhibitor some when offered at a low dose, and it changes to a serotonin and norepinephrine reuptake inhibitor at a higher dose.
- Nefazodone (Serzone) was found by at least one study to have a “broad spectrum of action” on PTSD.
- Ulmirtazapine /Mirtazapine (Remeron) has been looked at, especially for the insomnia associated with PTSD, and so far it has been found to work well. While there are trials going on, some of the side effects of Mitrazapine, while infrequent, seem severe, such as abnormal thinking, breathing problems, and abnormal dreams.
- Trazodone is used for insomnia and the nightmares people with PTSD experience. There has been some evidence it is useful for these uses.
- Other off label medications for PTSD include Citalopram (Celexa) and Fluoxetine (Prozac).
Medications for Comorbidity, Other Mental Conditions with PTSD
Major depressive disorder (MDD) can occur along with post-traumatic stress disorder. Since medication for this is the antidepressants, the prescription is less complicated than other comorbidities.
If the patient also has bipolar disorder, mood stabilizers are considered, but they have been found to be tricky to prescribe with many potentially dangerous side effects. Tegretol, Depakote and Lamictal all require vigilant monitoring by a physician.
Comorbidity with psychotic disorders can require adjunct therapy. Studies have found a link between chronic PTSD and psychosis. Sometimes the psychosis is diagnosed and the PTSD is missed. Symptoms might include hearing voices and having delusions. Antipsychotics affect the serotonergic systems, which is similar to the best medications for PTSD, but some also affect the dopaminergic systems.
Some new drug research is being done on PTSD. Note that these treatments have not been confirmed and accepted by the FDA as of 2012:
- Naval Medical Center San Diego researcher are experimenting with stellate ganglion block treatment, specifically injecting volunteers with PTSD with a drug used as an anesthetic.
- D-cycloserine (DCS) has been used in the past for an antibiotic, but has been combined with therapeutic exposure therapy to teach people with PTSD new ways to process fear inducing situations.
- MDMA (3,4-Methylenedioxymethamphetamine) is called Ecstasy on the street and is used illegally as a psychedelic but researchers are looking at it along with intense psychotherapy.
Patients should always be carefully monitoring while on prescription medication and should alert their doctors of any change in symptoms.