The Types Of Ptsd Symptoms
There are four types of post-traumatic stress disorder symptoms. They include:
- Intrusive memories.
- Negative feeling and thinking.
- Physical and emotional reactions when triggers occur.
In order to implement the right PTSD therapy techniques, there needs to be a diagnosis of the disorder. The physician will look to find out what happened during the event or experience and how long ago it occurred. The person would have to recount the memory as best as they can though this can be challenging due to the aversion symptom in PTSD patients.
Selective Serotonin Reuptake Inhibitors
The neurotransmitter serotonin has a well-recognized role in the experience of mood and anxiety disorders. The activity of this neurotransmitter in both the peripheral and central nervous systems can be modulated by SSRIs.
The SSRIs sertraline and paroxetine are the only medications approved by the FDA for PTSD. While SSRIs are typically the first class of medications used in PTSD treatment , exceptions may occur for patients based upon their individual histories of side effects, response, comorbidities and personal preferences.
Examples of an exception would be:
- A patient with PTSD and co-occurring bipolar disorder where an antidepressant could cause mood instability that could be mitigated with a mood stabilizing medication before prescribing an SSRI.
- Intolerable sexual dysfunction or gastrointestinal side effects due to the effects of increased serotonin levels in the peripheral nervous system.
Each patient varies in their response and ability to tolerate a specific medication and dosage, so medications must be tailored to individual needs. Research indicates that maximum benefit from SSRI treatment depends upon adequate dosages and duration of treatment. Ensuring treatment adherence is key to successful pharmacotherapy for PTSD. Some typical dosage ranges for medications:
- Sertraline : 50 mg to 200 mg daily
- Paroxetine : 20 to 60 mg daily
- Fluoxetine : 20 mg to 60 mg daily
What Are The Risks
The risks of taking SSRIs and SNRIs are mild to moderate side effects such as upset stomach, sweating, headache, and dizziness. Some people have sexual side effects, such as decreased desire to have sex or difficulty having an orgasm. Some side effects are short-term, though others may last as long as you are taking the medication.
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How Does It Work
PTSD may be related to changes in the brain that are linked to our ability to manage stress. People with PTSD appear to have different amounts of certain chemicals in the brain than people without PTSD. The four recommend SSRIs and SNRIs are believed to treat PTSD by putting these brain chemicals back in balance.
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Are There Other Medication Options For Ptsd
There are other medications that may be helpful, although the evidence behind them is not as strong as for SSRIs and SNRIs . These include:
- Nefazodone A serotonin reuptake inhibitor that works by changing the levels and activity of naturally occurring chemical signals in the brain.
- Imipramine A tricyclic antidepressant which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood.
- Phenelzine A monoamine oxidase inhibitor which inactivates a naturally occurring enzyme which breaks down the neurotransmitters serotonin, norepinephrine and dopamine.
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What Treatment Was Like For Me
- Helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound .
There are other types of trauma-focused psychotherapy that are also recommended for people with PTSD. These include:
- Written Narrative ExposureInvolves writing about the trauma during sessions. Your provider gives instructions on the writing assignment, allows you to complete the writing alone, and then returns at the end of the session to briefly discuss any reactions to the writing assignment. The most well studied written narrative exposure therapy is called .
- Brief Eclectic Psychotherapy A therapy in which you practice relaxation skills, recall details of the traumatic memory, reframe negative thoughts about the trauma, write a letter about the traumatic event, and hold a farewell ritual to leave trauma in the past.
- Narrative Exposure Therapy Developed for people who have experienced trauma from ongoing war, conflict, and organized violence. You talk through stressful life events in order and put them together into a story.
- Specific cognitive behavioral therapies for PTSDInclude a limited number of psychotherapies shown to work for PTSD where the provider helps you learn how to change unhelpful behaviors or thoughts.
Antidepressants
There are four antidepressant medications that are recommended for PTSD:
- Sertraline
- Fluoxetine
- Venlafaxine
NOTE: Medications have two names: a brand name and a generic name
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Acceptance And Commitment Therapy
This behavioral treatment for emotional trauma helps those with PTSD to be open enough about what they experienced. Often, someone with PTSD will do everything they can to escape the pain that surround the experience. The focus is on living a life of meaning and be willing to experience the inner feelings that exist. Meditation is an overall tool for wellbeing and can be a good exercise to begin accepting reality.
Other Interpersonal Psychotherapy Approaches
Other approaches, in particular involving social supports, may also be important. An open trial of interpersonal psychotherapy reported high rates of remission from PTSD symptoms without using exposure. A current, NIMH-funded trial in New York City is now comparing interpersonal psychotherapy, prolonged exposure therapy, and relaxation therapy.
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What Is The Best Natural Stress Relief For Ptsd
10 Remedies For Post-Traumatic Stress Disorder: Green Tea. As we have discussed above that PTSD, though a mental disorder, it also affects the hormonal balance and immune response of the body. Dong Quai. To calm the overactive adrenal glands highly sensitive nervous system that usually accompanies PTSD, the ancient Chinese herb Dong Quai can be very helpful. Basil.
Other Medications For Ptsd
Topiramate is in the anti-epileptic category of medications and is thought to modulate glutamate neurotransmission. There has been recent interest in its use for PTSD. The systematic review that served as the evidence base for the guideline development panel reported moderate strength of evidence for a medium to large magnitude effect for PTSD symptom reduction.
However, the panel concluded that there was insufficient evidence to make a recommendation because the potential side effects/harms for topiramate are greater than they are for SSRI antidepressants. It is not uncommon for patients taking topiramate to note side effects of cognitive dulling. Topiramate has also been found helpful in reducing alcohol consumption in those with an alcohol use disorder, which frequently accompanies PTSD.
Adapted from with original content written by Matt Jeffreys, MD. Matthew J. Friedman, MD, PhD, Thomas Mellman, MD and Jeffrey Sonis, MD, MPH also contributed.
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Introduction: Ptsd And Medical Marijuana
Those who have PTSD may have disturbing feelings and thoughts for a long time after the occasion. As well as feeling angry, dreadful, and alone, they may even experience flashbacks or have nightmares.
It is essential to understand that PTSD can happen to absolutely anybody, and it doesnt cause weakness. It is more typical after a specific type of traumatic event, including sexual assault or battle.
In numerous states with legalized marijuana, PTSD is on the list of qualifying conditions. It is because individuals suffering from the disorder have professed to see their symptoms decreased after using cannabis. However, certain marijuana strains will be more useful for PTSD patients than others.
Late research has discovered that CBD content can help individuals reduce learned fears, which scientists accept is one of the underlying causes of PTSD. Additionally, THC content can help as well.
THC and CBD benefit in distinctive ways. Some medical marijuana strains dominate CBD content, others have more THC content, and some have a right parity of them both. Each has something to contribute to individuals who have PTSD.
Questions The Healthcare Provider May Ask You
During your appointment, your healthcare provider may ask the following questions to better inform the diagnosis of PTSD:
- Have you experienced a life-threatening event that has caused fear, helplessness, or horror?
- Do you have repeated memories of a stressful experience from your past?
- How do you feel when youre reminded of said stressful event?
- Do you avoid activities or situations that remind you of a stressful event from the past?
- Have you been isolating yourself from others?
- Do you feel irritable or have outbursts?
- Do you have difficulty concentrating on daily tasks?
- Are you experiencing symptoms of depression or anxiety?
- Do you feel like youre losing a sense of control?
- Have you been waking up in the middle of the night from nightmares?
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Class Discussion: Weighing Approval Of A New Miracle Drug
Teachers should read the following two paragraphs aloud before splitting the classroom into two groups:
A new pill has been made that helps people lose five pounds every time they take it. The weight loss community is going crazy about this new miracle drugbegging for the FDA to finally approve it so that people can lose weight instantly and feel more confident.
But there are drawbackstaking the drug increases the risk of many diseases, including heart disease. The drug also makes you age faster. Lastly, the drug takes away all appetite, so much so that it is difficult for a person taking the drug to get their daily nutrients from food.
Split the classroom into two groups. Half the class will act as lawyers arguing for the drugs approval, and the other half will serve as the FDA listening and responding with concerns. Whose arguments will be stronger?
This brief was written by Bella Ratner as part of the 2017 Summer Internship Program at NYU Langones Division of Medical Ethics.
Implications And Future Directions
PE, CPT and trauma-focused CBT have been strongly recommended as treatments for PTSD in treatment guidelines by the APA and the VA/DoD. Each of these treatments have a large evidence base supporting their effectiveness in treating PTSD. Although exposure-based therapies have the largest and strongest research evidence base , research and meta-analyses comparing PE, CPT and trauma-focused CBT do not find that one treatment outperforms the other .
The guidelines and strong research evidence suggest that PE, CPT and trauma-focused CBT should be the first line of treatment for PTSD whenever possible, considering patient preferences and values and clinician expertise. Research examining patient preferences suggests that individuals prefer PE, CPT and trauma-focused CBT to other treatments. Analog studies have demonstrated that participants have preferences for CT and exposure therapy over psychodynamic psychotherapy, EMDR, and therapies using novel technologies . In addition, results from studies examining clinical samples show that patient prefer psychotherapy, such as PE and CBT, to medication . Findings are similar among veteran and military samples, with soldiers showing greater preference for PE and virtual reality exposure to paroxetine or sertraline and veterans in a PTSD specialty clinic showing greater preference for CPT to other psychotherapies, PE to nightmare resolution therapy and PCT, and both PE and cognitive-behavioral conjoint therapy were preferred to VRE .
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Is It Possible To Prevent Ptsd
While disaster-preparedness training is a good idea in terms of improving the immediate physical safety and logistical issues involved with a traumatic event, such training may also provide important preventive factors against developing PTSD. That is as evidenced by the fact that those with more professional-level training and experience tend to develop PTSD less often when coping with disaster than those without the benefit of such training or experience. People who have experienced trauma but are not members of those professions have been found to be less likely to develop PTSD if they receive imaging exposure and therapeutic processing by trained professionals within a day of the trauma and weekly sessions for at least two weeks thereafter.
There are medications that help prevent the development of PTSD. Some medicines that treat depression, decrease the heart rate, or increase the action of other body chemicals are effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.
Talking Treatments For Ptsd
The National Institute for Health and Care Excellence the organisation that produces guidelines on best practice in health care currently recommends two types of talking treatment for PTSD:
- Trauma-focused cognitive behavioural therapy . This is a form of cognitive behavioural therapy specifically adapted for PTSD. NICE recommends that you are offered 812 regular sessions of around 6090 minutes, seeing the same therapist at least once a week. See our pages on for more information about this therapy.
- Eye movement desensitisation and reprocessing . This is a fairly new treatment that can reduce PTSD symptoms such as being easily startled. It involves making rhythmic eye movements while recalling the traumatic event. The rapid eye movements are intended to create a similar effect to the way your brain processes memories and experiences while you’re sleeping. EMDR UK & Ireland – a professional association of EMDR clinicians and researchers – provides extensive information about EMDR on its website.
NICE may recommend other talking treatments in future if they are found to help with PTSD, but more research is needed.
“One of the most disturbing things has been the feelings of aggression and anger towards anyone who looks like the person who attacked me… EMDR therapy has been massively helpful.”
What if I don’t feel better?
If the talking treatment you try doesn’t seem to be helping, NICE suggests that you:
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How Talk Therapy Can Be Used To Help Treat Ptsd
Psychotherapy, or “talk therapy,” is a common treatment that involves talking with a doctor or other mental health professional about your condition. This type of therapy can occur one-on-one or in a group setting.
PTSD is one diagnosis for which the psychotherapy modalities, which are evidence-based, are shown to be far more effective than any medication, Dr. Hunter says. Those modalities include therapies like prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization .
A core component of the most effective therapies is that you talk to someone who helps you learn how to manage your symptoms yourself, Hunter explains.
Essentially, the idea behind talk therapy is that it can bring out a patients flight or fight response, and then help him or her move thoughts from survival mode to the intellectual processing areas of the brain, like the frontal cortex, Yeager explains. That process, in turn, helps the patient process his or her experience on a logical level and helps reframe the traumatic experience so they no longer blame themselves or make statements like I should have or if I had only, he says.
Avoidance And Emotional Numbing
Avoidance and emotional numbing The person with PTSD may try to avoid reminders of the event. They may avoid people or places that remind them of what happened. They will have a hard time talking about their experience and try to push the memories out of their mind. This is why many people with PTSD will have co-occurring disorders where they become addicted to substances. Someone with PTSD may emotionally numb themselves by working on not feeling anything.
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What Is A Treatment Plan For Someone With Ptsd
For PTSD, cognitive therapy often is used along with exposure therapy. Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares.
Can Ptsd Be Treated Without Medication
Sometimes. Although medications can be helpful in managing PTSD for some people, treatment should also include psychotherapy and counseling. Psychotherapy is a highly recommended treatment for people with PTSD as it helps people cope with the memory of their trauma and helps them process the experience.
People may respond better to certain treatments, whether it is different types of psychotherapy or medications. Therefore, you should thoroughly discuss these options with your provider to determine your best option.
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Primary Care Treatment Of Post
JENNIFER TRAVIS LANGE, CAPT, MC, USA, CHRISTOPHER L. LANGE, CAPT, MC, USA, and REX B.G. CABALTICA, M.D., Eisenhower Army Medical Center, Fort Gordon, Georgia
Am Fam Physician. 2000 Sep 1 62:1035-1040.
See related patient information handout on post-traumatic stress disorder, written by the authors of this article.
This article exemplifies the AAFP 2000 Annual Clinical Focus on mental health.
Post-traumatic stress disorder, a psychiatric disorder, arises following exposure to perceived life-threatening trauma. Its symptoms can mimic those of anxiety or depressive disorders, but with appropriate screening, the diagnosis is easily made. Current treatment strategies combine patient education pharmacologic interventions, such as selective serotonin reuptake inhibitors, trazodone and clonidine and psychotherapy. As soon after the trauma as possible, techniques to prevent the development of post-traumatic stress disorder, such as structured stress debriefings, should be administered. A high index of suspicion for post-traumatic stress disorder is needed in patients with a history of significant trauma.
Post-traumatic stress disorder can affect a wide range of patients in family practice, regardless of culture, age, sex or socioeconomic class. Busy clinicians need to be aware of its possible diagnosis to provide compassionate and effective care to affected patients or to initiate preventive interventions to those at risk.