What Treatments Are There For Ptsd

Types Of Medications Used To Treat Ptsd

PTSD Treatment: Know Your Options

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.

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

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 4 recommended SSRIs and SNRIs are believed to treat PTSD by putting these brain chemicals back in balance.

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Try Yoga Or Meditation

Recent studies have shown that meditation and yoga are helpful complementary therapies for people with PTSD.

While yoga or meditation may not provide complete relief from symptoms, researchers recommend them as additions to therapy and medication.

Yoga may help you regulate your breathing, increase your awareness of your body, and respond to changing emotions.

Meditation may help you redirect your attention to the present moment, giving you a greater sense of control over intrusive memories.

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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What Is An Evidence

There are lots of ways to treat PTSD. Not all of them are equally effective. Some could have serious side effects. So, it makes sense to seek out treatments that are backed by sound scientific evidence. These treatments are known as Evidence-Based Treatments.

An evidence-based treatment is judged on three main criteria:

1. The number of scientific studies that have been conducted. One study isnt really enough to determine whether or not a treatment works. Confidence in a given treatment grows when findings are replicated across multiple studies. This is especially true when different researchers in different settings find similar results.

2. The quality of those studies. Not all scientific studies are created equal. Randomized, Double-Blind, Placebo-Controlled studies are the gold standard. It also matters that the participants in the study are representative of the population by whom the treatment would be used. This is the only way to be sure that the results were caused by the treatment in question and not some other variable.

3. Whether or not experts agree on the conclusions. Studies are published in journals and undergo a peer review process where every aspect of the study is analyzed. They are also reviewed by professional organizations like the American Psychiatric Association who identify them as Evidence-Based and form guidelines for treatment.

Are There Other Medication Options For Ptsd

PTSD Treatment Works

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.

Beyond Treatment: How Can I Help Myself

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH’s Help for Mental Illnesses page or search online for mental health providers, social services, hotlines, or physicians for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

To help yourself while in treatment:

Talk with your doctor about treatment options
Engage in mild physical activity or exercise to help reduce stress
Set realistic goals for yourself
Break up large tasks into small ones, set some priorities, and do what you can as you can
Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
Expect your symptoms to improve gradually, not immediately
Identify and seek out comforting situations, places, and people

Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events .

Cognitive Behavioral Therapy Treatments

Cognitive behavioral therapy is an increasingly popular form of therapy that initially became well known in the 1980s. It blends the principles behind cognitive psychology and behavioral therapy to create a comprehensive treatment approach. The cognitive element focuses on the ways the human ability to problem-solve and think rationally can aid recovery. The behavioral element focuses on the ways in which the health of the mind manifests through human behavior. Most cognitive behavioral therapists will work on helping the PTSD sufferer come to terms with the traumatic event and then find ways to modify behavior to cope more efficiently.

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How Is Ptsd Conventionally Treated

Generally, PTSD is treated with therapy, medication, or a combination of the two. While this approach can be highly effective for some individuals, remission rates remain high at around 3040%.¹

Despite the high prevalence of PTSD , research into the most effective therapies remains surprisingly limited. The effects of treatment between individuals can be highly variable. There is often low compliance with medication or therapy, contributing to this variability.

Therapy options with the strongest evidence base include cognitive behavior therapy and eye movement desensitization and reprocessing . Conventional drugs administered for PTSD are antidepressants, mainly sertraline and paroxetine.

The stigma around PTSD remains high, leaving individuals misunderstood and seen as dangerous, incompetent, or responsible for their condition.

Stigma has been identified as contributing to increased helplessness and reduced functional recovery in some individuals with PTSD. As a result, there is a growing need to change the way PTSD is both understood and treated particularly for those who arent responding to traditional medicine.

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, its important to remember that you werent to blame for what happened, and you can regain your sense of safety, trust, and self-worth.

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Which Is More Effective For Treating Ptsd: Medication Or Psychotherapy

By Thomas Hughes

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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Is There A Cure For Ptsd

As with most mental illnesses, no cure exists for PTSD, but the symptoms can be effectively managed to restore the affected individual to normal functioning. The best hope for treating PTSD is a combination of medication and therapy. By working with a healthcare professional, individuals with PTSD can resolve their triggering factors and learn new and effective ways of coping with the stress of the past trauma.

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Do Not Avoid Talking About Trauma For Fear Of Re

PTSD is a disorder that creates and maintains avoidance . You may fear causing distress and re-traumatizing the client by talking about their past trauma and upsetting them. Understandably, you want to make your clients feel happy and soothe them. Exposing them to the past trauma in a controlled and safe manner can help them undo the trauma.

Suggested Treatments: Treatments With Some Research Support

Medications for PTSD

Some psychotherapies do not focus on the traumatic event, but do help you process your reactions to the trauma and manage symptoms related to PTSD. The research behind these treatments is not as strong as the research supporting trauma-focused psychotherapies . However, these psychotherapies may be a good option if you are not interested in trauma-focused psychotherapy, or if it is not available:

Stress Inoculation Training A cognitive-behavioral therapy that teaches skills and techniques to manage stress and reduce anxiety.
Present-Centered Therapy Focuses on current life problems that are related to PTSD.
Interpersonal Psychotherapy Focuses on the impact of trauma on interpersonal relationships.

There are also 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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Ptsd In Military Veterans

For all too many veterans, returning from military service means coping with symptoms of PTSD. You may have a hard time readjusting to life out of the military. Or you may constantly feel on edge, emotionally numb and disconnected, or close to panicking or exploding. But its important to know that youre not alone and there are plenty of ways you can deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.

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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.

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Psychological Treatment Setting And Duration

Psychological treatment should be regular and continuous. The trauma-focussed component of treatment is best delivered at least once a week. Eight to twelve weeks of trauma-focussed treatment is usually sufficient when the PTSD results from a single event. Veterans can expect treatment sessions in which the trauma is discussed to last for about 90 minutes. It may be necessary to extend the duration of trauma-focussed treatment beyond 12 sessions for more complex cases, such as veterans with:

chronic disability resulting from trauma
significant comorbid disorders
a history of multiple traumatic events

Disinhibited Social Engagement Disorder

Finding Trauma Therapy for PTSD Treatment

Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of 2. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers prevent them from forming stable attachments.

Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. These behaviors cause problems in the childs ability to relate to adults and peers. Moving the child to a normal caregiving environment improves the symptoms. However, even after placement in a positive environment, some children continue to have symptoms through adolescence. Developmental delays, especially cognitive and language delays, may co-occur along with the disorder.

The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. Treatment involves the child and family working with a therapist to strengthen their relationship.

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