What Are Some Common Symptoms Of Ptsd
PTSD symptoms typically fall into one of four categories. People may experience many of these symptoms or only a few. Because of the different ways that post-traumatic stress disorder can manifest, it can sometimes be hard to diagnose the disorder.
Reliving Traumatic Events
- blaming themselves for the traumatic event
- experiencing overwhelming feelings and thoughts of guilt, anger, sadness, or shame
Which Is More Effective For Treating Ptsd: Medication Or Psychotherapy
A systematic review and meta-analysis led by Jeffrey Sonis, MD, MPH, of UNCs departments of social medicine and family medicine, finds there is insufficient evidence at present to answer that question. Clinicians should make shared decisions with patients about treatment, and they should not rely on current treatment guidelines.
A systematic review and meta-analysis led by Jeffrey Sonis, MD, MPH, of UNCs departments of social medicine and family medicine, finds there is insufficient evidence at present to answer that question. Clinicians should make shared decisions with patients about treatment, and they should not rely on current treatment guidelines.
CHAPEL HILL, N.C. A new study that sought to find out whether serotonin reuptake inhibitors or trauma-focused psychotherapy is more effective in treating posttraumatic stress disorder concluded there is insufficient evidence at present to make that determination.
The systematic review and meta-analysis was led by Sonis and is published in the December 2019 issue of the journal Psychiatry Research. Joan M. Cook, PhD, of Yale University is co-author of the study.
Until there is clear evidence from head-to-head trials favoring one treatment or the other, Sonis said, clinicians should make shared decisions, with patients, about which treatment modality to use, based not on comparative effectiveness but on patient preferences regarding the following factors:
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Types Of Medications Used To Treat Ptsd
Sometimes medication for PTSD nightmares or other symptoms is prescribed. Typically, medication is used in conjunction with other treatment techniques like various forms of therapy. Most often, selective serotonin reuptake inhibitors antidepressants are prescribed. They can help treat the depression symptoms that often present with PTSD.
While just a couple of medications are approved by the Food and Drug Administration to treat PTSD, many others are also prescribed off-label. Off-label is when medication is prescribed in a manner that is not specified by FDAs packaging. An in-person or online psychiatrist can set up a treatment plan utilizing a combination of medications to relieve these troubling PTSD symptoms. For instance, the prescription is used for a different condition or the dosage is different than what the FDA recommends.
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The Link Between Sleep Apnea And Ptsd
Both obstructive sleep apnea and PTSD can lead to significant sleep disturbance. Therefore, studies have looked at a potential link between the two. While around 20% of people may have OSA, which remains undiagnosed in the large majority of cases, this figure can be seen to jump significantly in those with post-traumatic stress disorder.
One of the contributing factors for OSA is age, with older people more at risk of developing the disorder. However, in younger Iraq and Afghanistan military veterans, 69% tested positive for OSA according to one study. The takeaway from the study was that post-traumatic stress disorder increased the risk from sleep apnea.
What the studies also found was the presence of untreated OSA could worsen the symptoms and outcomes of post-traumatic stress disorder. Good sleep is an important tool in managing the nightmares and fears associated with the disorder. When someone suffering with PTSD awakes from a nightmare it is usually during the REM phase of their sleep. This is key, as the REM phase has been shown to help with fear extinction.
Someone whose sleep is disturbed due to post-traumatic stress may further their sleep deprivation if they also have OSA. Any condition which increases the chance of sleep disturbance could worsen their OSA symptoms, particularly if their OSA remains undiagnosed
Ptsd Treatment Typically Focuses On One Or More Types Of Therapy It May Also Include Medication And Additional Support Services And Interventions
The symptoms of post-traumatic stress disorder can be severe and manifest in different ways. Intrusive symptoms like flashbacks and nightmares can lead to heightened reactivity as well as to blunted emotions and dissociative symptoms. People with PTSD sometimes become more impulsive or aggressive but can also become withdrawn and avoidant. They can alternate between these different responses in unpredictable intervals.
To be effective, treatment for PTSD typically addresses this full range of symptoms. This means it must be multi-faceted, systematic, flexible and responsive. While PTSD treatment focuses on one or more types of therapy, it may also include medication and additional support services and interventions. PTSD treatment options and protocols are the focus of extensive research and are actively being improved as clinicians continue to study the effects of trauma.
Are you or a loved one dealing with a life-altering trauma and are struggling to cope? Contact Mental Health America at 1-800-273-TALK to find help today.
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Veterans Affairs And Defense Department Guidelines Updated
The VA/DoD clinical practice guidelines originally recommended off-label risperidone, olanzapine, or quetiapine for the adjunctive treatment of patients with PTSD.1 However, in view of the disappointing results from the recent VA-sanctioned study of risperidone in PTSD,44 the guidelines have been revised to recommend against the use of risperidone as adjunctive therapy.52 The revised guidelines further state that there is insufficient evidence to recommend for or against the use of any other atypical antipsychotic as an adjunctive therapy for the treatment of PTSD.
Table 2 depicts the VA/DoDs current assessment of the drugs used to treat PTSD .52
Rape Or Sexual Trauma
The trauma of being raped or sexually assaulted can be shattering, leaving you feeling scared, ashamed, and alone, or plagued by nightmares, flashbacks, and other unpleasant memories. But no matter how bad you feel right now, it’s important to remember that you weren’t to blame for what happened, and you can regain your sense of safety, trust, and self-worth.
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Dropout Side Effect And Adverse Effects
One common concern with trauma-focused treatment is dropout and rates of dropout appear to be similar across PE, CPT and trauma-focused CBT . A substantial minority of individuals drop out of PTSD treatment . Imel et al. conducted a meta-analysis of treatment dropout in PTSD treatment. The aggregate proportion of dropout across all active treatments was 18.28%, however, there was a large amount of variability across studies. The dropout rate varied between active interventions for PTSD across studies, but the differences were primarily driven by differences between studies. In addition, an increase in trauma focus did not predict an increase in the dropout rate. Imel et al. did find evidence across three relatively large trials that dropout is lower in present centered therapy compared to trauma specific treatments .
Unfortunately, few studies explicitly report on side effects and adverse effects of PTSD psychotherapy . The American Psychological Association guidelines recommends that research be conducted on side effects. When examining the results of large controlled trials there is no evidence that trauma-focused treatments are associated with a relative increase in adverse side effects . Clearly more research should examine and report on side effects and adverse effects of PTSD treatment.
Medications To Treat Post
Post-traumatic stress disorder affected an estimated 3.6% of adults in the United States in the last year. Although its often associated with combat veterans, children and adults can be diagnosed with PTSD as well.
PTSD is a mental health condition is a severe form of anxiety disorder that can last for months or years after someone witnesses or experiences trauma. Triggers can cause the trauma to resurface, resulting in extreme physical and/or emotional responses. Some common symptoms that can affect your everyday life include nightmares, flashbacks, anger, irritability, negative thoughts, sleep disturbance, or hyperarousal symptoms. Those with PTSD may even find themselves experiencing anxiety or depression in conjunction.
There are many treatment options for post-traumatic stress disorder, including PTSD medication and various therapy techniques. The most important thing to keep in mind when considering the right PTSD treatment medication or therapy is that since no two people have the same experience and treatment generally isnt a one-size-fits-all plan.
You might need to try different techniques before something works well for you and your symptoms. In the end, finding a mental health professional with experience in treating PTSD is likely going to be your best bet. Whether this means finding the best medication for PTSD or engaging in short-term trauma-focused CBT for PTSD, there are treatment options out there for you.
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Emotional And Psychological Trauma
If you’ve experienced an extremely stressful eventor series of eventsthat’s left you feeling helpless and emotionally out of control, you may have been traumatized. Psychological trauma often has its roots in childhood, but any event that shatters your sense of safety can leave you feeling traumatized, whether it’s an accident, injury, the sudden death of a loved one, bullying, domestic abuse, or a deeply humiliating experience. Whether the trauma happened years ago or yesterday, you can get over the pain, feel safe again, and move on with your life.
Explore Online Therapy Options
Another type of therapy option is online therapy. Online therapy allows you the freedom to attend therapy sessions from the comfort of your home, which may be less intimidating and more accessible than other types of therapy. It also gives you the freedom to get treated in a number of different ways, including your phone, computer, or an app.
The National Center for PTSD provides a number of resources, including:
- video tutorials that can educate you in greater depth about symptoms and treatments
- PTSD Treatment Decision Aid to help you decide which options suit your needs best
- online programs to help you deal with stress, anger, parenting challenges, and sleep issues
How to find a therapist thats right for you
To find a therapist who can help you with PTSD, consider the following strategies:
And finally, give yourself permission to change therapists.
The first therapist you visit might not turn out to be a good fit. Its OK to consider your initial visits as a kind of interview process to find the therapist thats right for you.
Cost and insurance
Most insurance plans offer some coverage for mental health services, although deductible amounts and copays will vary from policy to policy.
Original Medicare, Medicare Advantage plans, and Medicaid also provide mental health benefits.
If you do not have health insurance and youre looking for affordable PTSD treatment, try looking for a therapist who has a sliding-scale fee structure.
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Ptsd Treatment And Therapy
Treatment for PTSD can relieve symptoms by helping you deal with the trauma you’ve experienced. A doctor or therapist will encourage you to recall and process the emotions you felt during the original event in order to reduce the powerful hold the memory has on your life.
During treatment, you’ll also explore your thoughts and feelings about the trauma, work through feelings of guilt and mistrust, learn how to cope with intrusive memories, and address the problems PTSD has caused in your life and relationships.
The types of treatment available for PTSD include:
Trauma-focused cognitive-behavioral therapy involves gradually exposing yourself to feelings and situations that remind you of the trauma, and replacing distorted and irrational thoughts about the experience with a more balanced picture.
Family therapy can help your loved ones understand what you’re going through and help you work through relationship problems together as a family.
Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, although they do not treat the causes of PTSD.
EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. EMDR therapy techniques work by unfreezing the brain’s information processing system, which is interrupted in times of extreme stress.
Eye Movement Desensitization And Processing Therapy
EMDP is a relatively new therapy that has been shown to effectively treat PTSD in several randomized controlled trials. During EMDP sessions, the client makes repeated, rhythmic eye movements while recalling the traumatic event to a mental health professional.
EMDP is based on the theory that PTSD occurs when your mind and body do not fully process a traumatic experience. Scientists believe that when an event is too scary or intense for us to handle, certain mental processes may just shut down. This means that we continue to be affected by the experience as though it is an ongoing event, explaining symptoms like flashbacks, hypervigilance, and mistrust.
The rhythmic eye movements in EMDP therapy aim to mimic the way our bodies process events and memories during our sleep. The therapy aims to help individuals finish processing the event so it no longer disrupts their lives.
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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 .
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 Medications Treat Ptsd And Which Is Right For Me
Post-traumatic stress disorder is a type of anxiety disorder that can occur after trauma, a threat, or a life threatening event. There are several medications that can help relieve the symptoms of PTSD.
Fear is a normal response to a shocking or traumatic situation. Some people may continue to experience anxiety or fear following the event. The anxiety or fear may alter their behavior, even after the perceived threat has passed. Sometimes these symptoms arise months or even years after the event.
A medical or mental health professional can diagnose PTSD. A person must experience symptoms for at least 1 month for a PTSD diagnosis to be made. Medications and talk therapy are first-line treatments.
There are four kinds of medications that treat PTSD. However, only two of them currently have approval from the Food and Drug Administration specifically to treat the condition. All four medications are antidepressants that act on the levels of neurotransmitters in the brain.
The FDA-approved medications for PTSD are sertraline and paroxetine . The other two medications are fluoxetine and venlafaxine .
A doctor or psychiatrist can determine which medication is the best option and make adjustments based on the bodys response.
What Is The Evidence For Specific Classes Of Medications Used For Ptsd Treatment
Selective serotonin reuptake inhibitors
The neurotransmitter serotonin has a well-recognized role in the modulation of a number of mood and anxiety disorders. For example, a deficiency in amygdala serotonin transport has been identified in some individuals with PTSD . The level of this neurotransmitter in both the peripheral and central nervous systems can be modulated by the selective serotonin reuptake inhibitors . Whereas SSRIs as a class were included as first line medications in the 2010 VA/DoD CPG, such across-the-board endorsement is no longer recommended since some SSRIs have either not been tested or have not shown efficacy for treating PTSD. Therefore, the revised 2017 VA/DoD CPG only lists three SSRIs along with the SNRI venlafaxine as strong recommendations for treatment of PTSD. These medications have the most robust empirical evidence for reducing PTSD symptoms in RCTs. They are the preferred medications to be used in PTSD treatment .
- sertraline 50 mg to 200 mg daily
- paroxetine 20 to 60 mg daily
- fluoxetine 20 mg to 60 mg daily
Note: Only sertraline and paroxetine have been approved for PTSD treatment by the FDA. All other medications described in this guide are being used “off label” and have empirical support and practice guideline support only.
Other antidepressants for PTSD
Examples of these antidepressant dosage ranges are listed below:
Mood stabilizers for PTSD
Atypical antipsychotics for PTSD
Prazosin
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