How Do Medications Help Regulate Biological Responses In Ptsd
The medications prescribed for treating PTSD symptoms broadly act upon neurotransmitters affecting the fear and anxiety circuitry of the brain including serotonin, norepinephrine, gamma-aminobutyric acid , the excitatory amino acid glutamate and dopamine, among many others. Note that there are a number of different glutamatergic receptors, including NMDA , AMPA , kainate and metabotropic, all of which are potential targets for different medications. There is great need to develop agents with novel and more specific mechanisms of action than are currently available to target the PTSD symptoms described earlier while also minimizing potential side effects.
Studies show that a number of medications are helpful in minimizing PTSD symptoms. Most of the time, medications do not entirely eliminate symptoms, but provide symptom reduction, while trauma-focused psychotherapy such as CPT, PE and EMDR are strongly recommended as the most effective treatments .
How To Help Treat Ptsd By Using Oral Medication
Trauma psychotherapies are generally first-line treatments, Connors says. After a complete psychiatric assessment, the treating prescriber may recommend medication for comorbid disorders, like attention deficit hyperactivity disorder or depressive disorders.
Older patients may sometimes have less success with medication approaches for PTSD treatment compared with younger patients because they do not process medication the same way, Dr. Yeager adds.
Common drugs prescribed to treat PTSD include:
Antidepressants These drugs help control symptoms of depression and anxiety.
Antidepressants, like Paxil , Zoloft , Prozac , and Effexor a serotonin and norepinephrine reuptake inhibitor , rather than a selective serotonin reuptake inhibitor like the others are commonly prescribed for PTSD, though only sertraline and paroxetine are currently approved by the Food and Drug Administration , Yeager says, citing the National Center for PTSD. Side effects of these drugs may include headache, nausea, muscle spasms, agitation, or sexual problems.
Antidepressants also carry a warning because they may raise the risk of suicidal thoughts in children, teens, and young adults.
Anti-Anxiety Drugs These drugs can help relieve feelings of anxiety and stress. They’re usually not taken long term because of their potential for abuse.
Antipsychotics These medicines are sometimes given to people with PTSD to control certain severe symptoms.
Questions You Should Ask Your Healthcare Provider
If you do have PTSD, its important to understand its causes and course of action over the short- and long-term. Here are some of the more important questions to ask your healthcare provider during your appointment:
- What exactly is post-traumatic stress disorder?
- How long does PTSD last?
- Do children react differently than adults to PTSD?
- How do I live with PTSD?
- What treatments are available?
- What is the best medication for me to take?
- What lifestyle changes can I make to help regulate symptoms of PTSD?
If youre experiencing PTSD symptoms, your healthcare provider might refer you to a clinical psychologist, psychiatrist, psychotherapist, or other mental health professional to determine what treatment or treatment programs are best.
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What Are Some Of The Biological Disturbances Found In Ptsd
The biological disturbances in PTSD can be conceptualized as a dysregulation of the hypothalamic-pituitary-adrenal axis and the balance between excitatory and inhibitory brain neurocircuitry. There is a resultant dysregulation of adrenergic mechanisms that mediate the classical fight, flight or freeze response.
Patients with PTSD have abnormal HPA function as compared to patients without PTSD and have a much greater variation in their levels of adrenocorticoids . A recent study measuring salivary cortisol levels found decreased cortisol variability for responders to PE with continued high variability in cortisol levels for non-responders . Further study of this complex interaction between cortisol levels and successful treatment is needed.
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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How Long Does Treatment Last
PTSD is a chronic condition that requires long-term treatment, but that treatment plan can change over time based on the severity of symptoms.
Most patients that are started on SSRI/SNRI medications typically feel their effects after six to eight weeks of treatment. However, some people may feel these effects sooner. Patients should schedule regular follow-ups with their providers to discuss whether or not the medical therapy is helping, if the side effect profile is tolerable, and whether patients would like to change their treatment plan. Along with medications, patients should be getting trauma-based therapy as well and discussing symptoms with their entire care team. It is very important that patients do not change their plan without first consulting their providers, as it increases the risks of adverse effects.
Related Resources For Ptsd
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
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Do Not Fight Ptsd On Your Own
Many people think they can overcome the symptoms of PTSD on their own, but most require outside help. A combination of medication and therapy is just what the doctor orders when dealing with PTSD. Staying with the treatment plan can help the patient get better over time. The right treatment helps patients live happy and fulfilled lives.
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What Are Some Of The Causes Of Ptsd
As mentioned, PTSD can often be caused by the traumatic experiences associated with military service however, other events can also lead to PTSD as well.
As it turns out, there are a multitude of reasons why someone might develop PTSD, many of which are not as obvious as being on the battlefield.
For example, the trauma of being in a car accident may be enough to cause PTSD symptoms, causing the individual to experience significant anxiety when confronted with things associated with the accident. They may avoid triggers such as the location where it occurred, or even resist the act of driving/riding in a car.
This type of event could be classified as a direct experience event because the person experienced the trauma of the car crash first-hand however, PTSD can also develop from indirect experiences as well.
An example of this dynamic might be a person who develops PTSD due to hearing several horrible stories of being trapped in an elevator in a high-rise building during a fire or earthquake. Indeed, the repeated exposure to these stories may be enough to elicit a stress response that develops into PTSD, despite the fact that the individual never had first-hand experience with the trauma.
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Ptsd And Alcohol Abuse Are Connected
Those with Post Traumatic Stress disorder have an increased likelihood of having an alcohol abuse disorder. Up to 40 percent of people who have PTSD likely abuse alcohol as well. When not treated properly, those who have PTSD can use alcohol and other drugs to self medicate. This means people who suffer from PTSD use alcohol and other drugs to attempt to deal with the symptoms of PTSD.
But self medication is often false hope, and alcohol and drugs can often make the problem worse. There are far better treatment options now for Post Traumatic Stress Disorder as well as alcoholism. Both of these diseases are treatable, and with care, almost everyone can get better.
Although PTSD can happen to anyone who has survived a traumatic experience experiences outside of normal human experience by definition this most often includes veterans who have experienced combat and have undertaken combat related duties. As many as 20 percent of veterans of the wars in Iraq and Afghanistan have post traumatic stress disorder.
If you or one of your loved ones displays symptoms of PTSD or alcoholism, it might be time to speak with a professional. At Midwood Addiction and Treatment, we can help with a number of services. Below, weve made a short list of symptoms and treatments for each disorder, which unfortunately go hand in hand.
Ptsd In Specific Populations
- The rate of PTSD is higher among veterans, likely due to their increased risk of exposure to trauma.
- Approximately 30 percent of Vietnam veterans are expected to develop PTSD at some point in their lives.
- Among Operation Iraqi Freedom veterans, the rate of PTSD is estimated to be between 11 and 20 percent.
- The rate of PTSD is estimated at 12 percent among Gulf War veterans.
- PTSD is more common among people who have experienced certain types of trauma. As many as 49 percent of rape victims will develop PTSD.
- 31.9 percent of physical assault victims will develop PTSD, as will 16.8 percent of people involved in a serious accident.
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Symptoms Of Alcohol Abuse And Addiction
Symptoms of alcohol abuse and addiction include:
- Inability to control alcohol use
- Drinking even when one says they wont
- Wanting to stop drinking and not being able to
- Consuming more alcohol than one wanted
- Drinking at inappropriate locations or in inappropriate situations
What Are Future Research Directions For Ptsd Pharmacotherapy
The pathophysiological mechanisms for PTSD in the brain are unknown, but there are several interesting neurotransmitters and pathways that could lead to new drug development for the treatment or the prevention of PTSD. There are competing hypotheses about the role of glucocorticoids following trauma and their effects on the brain. It might be possible to intervene at some level in the HPA axis or at the level of the glucocorticoid receptors in the brain to modulate the effects of stress and the development of PTSD. Some research suggests the potential ability of supplemental cortisol in reducing PTSD symptoms . Furthermore, in one small study, cortisol administered prior to PE demonstrated significantly better retention in treatment especially among those patients with increased sensitivity to glucocorticoids. The authors cite several actions of glucocorticoids including potentiating glutamate at NMDA receptors, decreased retrieval of fear memories and interactions with noradrenergic systems, as potential mechanisms of action on brain pathways affecting PTSD .
A recent study compared methylphenidate and the acetylcholinesterase inhibitor galantamine to placebo and found that methylphenidate, but not galantamine, improved cognitive complaints as well as PTSD symptom severity in patients with mild traumatic brain injury and/or PTSD. The authors propose larger randomized controlled trials to further evaluate improving cognition in those with PTSD and co-occurring mTBI .
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Can Ptsd Be Treated Without Medication
The first line treatment for PTSD involves trauma-based therapy. There are multiple types of therapies used to treat PTSD without involving medications. If patients elect to use medications as well, providers will still highly recommend therapy along with it.
The four most common therapies used to treat PTSD are:8
Can Ptsd Be Cured Without Medication
Though medications can help manage PTSD symptoms, there are other treatments that can make a difference. Some popular treatment options include talk therapy, cognitive processing therapy, prolonged exposure therapy, virtual reality therapy, eye movement desensitization and reprocessing, and stress inoculation training.
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
Choosing The Best Treatment For You
While there are guidelines for certain FDA-approved medications and first line therapy for PTSD, the specific treatments suggested will depend on a patients medical history, symptoms, and any concerns patients may have.
It is highly recommended that therapy be part of the treatment plan for all patients. If patients feel that the type of therapy they are trying does not improve their PTSD symptoms, it is important to try other types of approved therapy instead of giving up on therapy altogether. Similarly, if patients feel that therapy is helping but they need additional help, they should speak to their provider about whether trying a medication will be a good option for them.
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Holistic Treatment For Ptsd
For some people, the best way to treat PTSD if you dont want to go the medication route might be to try healing from PTSD naturally or using holistic treatment.
Much of the approach involves seeking a re-establishment of a personal balance, both in mind and body. While some critics argue holistic techniques dont measure up to western medical scientific approaches, many people whove gone the holistic route now swear by it for their own stability and recovery.
Some popular holistic PTSD treatments include:
Holistic treatments such as incorporating meditation, yoga, and journaling can be healing when treating PTSD. Working with a licensed therapist or psychiatrist who specializes in trauma can be extremely supportive in your healing journey.
Final Thoughts About Medications For Treatment Of Ptsd
A more comprehensive discussion of pharmacotherapy can be found online in the 2017 VA/DoD PTSD Clinical Practice Guideline.
Trauma-focused psychotherapies are more efficacious than pharmacotherapy and are strongly recommended treatments for PTSD. While there are few direct comparisons of pharmacotherapy and psychotherapy, the greatest benefits of treatment appear to come from evidence-based therapies such as CPT, PE and EMDR based upon the effect sizes in the literature. However, the role of pharmacotherapy in combination with trauma-focused psychotherapy is unknown at this time . Some patients prefer medication to psychotherapy, although when given the choice, the majority choose psychotherapy . Based upon current knowledge, most prescribing clinicians view pharmacotherapy as an important adjunct to the evidenced-based psychotherapies for PTSD. Patients need to be informed of the risks and benefits of the differing treatment options along with the risks of no treatment.
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Other Antidepressants For Ptsd
Antidepressants that affect the balance of serotonergic and noradrenergic neurotransmission, or which alter serotonin neurotransmission through other mechanisms of action, are also helpful in PTSD. Venlafaxine acts primarily as a serotonin reuptake inhibitor at lower dosages and as a combined serotonin and norepinephrine reuptake inhibitor at higher dosages. It is also a conditionally recommended treatment for PTSD. A typical dosage range is:
- Venlafaxine : 75 mg to 300 mg daily
All of the antidepressants described above are also effective in treating comorbid major depressive disorder which, depending upon the study, accompanies PTSD about 50 percent of the time. Dose-related elevations in blood pressure have been noted with venlafaxine. It should be used with caution in patients with hypertension.
How Effective Are Magic Mushrooms For Ptsd
Traumatic events like war, accidents, and losing a loved one can alter the connection in our brains, leading to PTSD.
Our brains are essentially wired to have a flight-or-fight response, which is responsible for determining how we respond to extreme events. While the fight response allows us to face the danger, the flight response gives us the strength to withdraw from the danger.
With PTSD, the brain is stuck in flight-or-fight mode, which can lead to a cluster of symptoms:
This will ultimately mess around with the brain’s function and ability to respond to events less violently. People who suffer from PTSD often have a replay of their bad experiences or occurrences, thus requiring total brain rewiring via medications and other activities.
The psilocybin in magic mushrooms can help restore neuroplasticity. It does this by interacting with serotonergic receptors. Serotonin receptors are responsible for biological and neurological processes like
They control how we respond to events. By interacting with these receptors, psilocybin and psilocin help to deal with anxiety, depression, PTSD, and addiction.
Several veterans have attested to the therapeutic activity of magic mushrooms in promoting mental balance. A 2022 study on army veterans suffering from trauma shows that all the participants who had used psilocybin reported immediate and long-term improvements in their symptoms.
Kruske had this to say about his magic mushroom trip: