Ptsd

CharlieRN · Jul 16, 2005

Drugs are not the treatment of choice for PTSD since they generally do not address the primery illness but only relieve secondary symptoms. However the secondary symptoms are frequently so severe that something must be done about them. Crippling anxiety is a frequent symptom of PTSD for which very effective medications exist. The benzodiazepines work very well. However they are contraindicated because PTSD anxiety is long term and will not generally resolve on its own. These meds are addictive and cannot be taken over the long term safely. That is not to say they are not prescribed that way!

There is nothing like xanax to stop an anxious patient from complaining. It is an easy out for the MD. Down the road, when the pharmacist informs the doc that the pt wants refills too often, it is the patient's problem that they are addicted. Then the indignat doc tells them to go elsewhere because he will not treat someone with an "addictive personality".

Sorry, how'd I get on this soap box?

The bottom line is that PTSD is a memory based disorder. The problem is that the patient has memories that are inconsistent with who they think they are, with their self image.

We really have no meds that directly address that. Talk therapies and experiencial therapies do address it because they help the pt reframe the experience in a way that is less threatening or they help the patient understand him/herself as being less vulnerable.

**RosesrReder, BSN, MSN, RN** · Jul 16, 2005

Not a nurse but I suffer from Post traumatic stress disorder. I went through counseling and psychiatric treatment, along with Wellbutrin. I know some people who have gone through treatment as well along with an entirely different drug. I believe it depends on what work.

GrnHonu99, RN · Jul 17, 2005

I realize that the best treatment for PTSD is counseling but I was given this topic in pharmacology. The Prof chose it for me and told me to find two drugs that are used in the treatment for PTSD...so far I have found one SSRI and one MAOI that have specific research trials...i mean i have that article anyway...any more suggestions?

CharlieRN · Jul 17, 2005

Wellbutrin, which I think of as primarily an antidepressent, is sometimes used. Other antidepressents could be used interchangably with it since what they would treat is the situational depression that often accompanies ptsd. Ptsd may also manifest as as a psychotic depression. In that case antipsychotics can be effective as part of the med plan, particularly as prn's. The most common presenting symptom will be anxiety. Benzodiazepines can be used for extream outburst of anxiety. My favorite all round psych drug is seroquel. It is an anti psychotic but, is generally free from nasty side effects. It is definately sedating so it is effective as an antianxiety med which will control episode of extream behavior, and there is reported to be anti derpressent effects as well.

So what I'm saying is that PTSD would be treated with an anti depressent, an anti anxiety agent, possibly a little "glue" in the form of an anti psychotic. There is also a place for a heavy duty sedative for when symptoms peak. There is no one drug that by itself is perfect. There does not need to be since the meds are just holding things together while the patient heals. Meds in PTSD are like aspirin for the fever while treating a pneumonia, they help manage troublesome symptoms.

TitaniaSidhe · Jul 17, 2005

I work in the VA system & we have a PTSD program/unit in the hospital where I work. Since I am in admissions they frequently come through my unit for referal/ stabalization prior to attending the program. I frequently see the following prescribed- Paxil, Prozac, Depakote, Trazadone. Mind you these are predominantly combat vets with an occasional episode of PTSD secndary to something other than combat- sexual abuse etc.. Higher levels of agression & drug dependance are seen in this group.

krisssy · Jul 29, 2005

I was given Zyprexa for PTSD. It worked very well, but was very difficult to get off although I was told it is not addictive.

GrnHonu99, RN · Jul 30, 2005

thanks for the advice guys, im busily looking up all your suggestions in my drug book:) I still think it so strange that my pharm teacher gave me PTSD to wirte a pharmacology paper on! I was a psych major undergrad so my first thought was also therapy...i think its going to be a good paper though, im either going to use SSRIs and MAOIs or benzodiazapenes and antipsychotics..:) thanks again!

krisssy · Jul 30, 2005

Four years ago , something very traumatic happened to me , and I was suffering from severe PTSD with severe symptoms of anxiety and major depression. These were basically the symptoms of the PTSD. The Zyprexa was what eventually worked (an anti psychotic) but before that they tried Paxil and Xanax. I got addicted to the Xanax and when he upped the dosage to 2mg. four times a day, I blacked out and took the whole bottle in a black out. It was a disaster,. I can tell you that therapy did not work at all at the time. The Zyprexa worked, now I am off it, stable and ready for therapy to deal witth the PTSD. Therapy could not work at the time. The symptoms were too extreme. After the Xanax disaster, they tried Seroquel.. It had a reverse effect. So I guess the combination of Paxil(which I am still on) and Zyprexa (which I don't need anymore) is what worked in the end.

Thunderwolf, MSN, RN · Jul 31, 2005

What is interesting about this (PTSD and meds vs/and counseling) is that counseling can often become ineffective IF the person is in acute states of their illness. During these times, meds may become the only answer to relieving the symptom picture. When the sufferer is in acute distress, mentally/emotionally attending to therapy/counseling may be very difficult for the patient...if not down right frustrating. The counselor's theoretic approach to counseling also is a factor. There was one medical article I read many months ago (I forget which) that concluded that counseling for PTSD was not found to be very effective as a form of treatment. Again, this was one article...and I believe it referred to counseling approaches that focus on going back to the trauma in order to heal. In this sense, I probably would agree. Being retraumatized in therapy is not very therapeutic. For PTSD sufferers, therapy/counseling needs to be a safe, grounding experience. As an ex-counselor and as a PTSD sufferer (in much of his remission at present), the counseling approach which appears to help was very reality based, "present" and trigger/symptom focused, understanding one's symptoms for what they were, and addressed one's coping for living in the present despite the mind-body's tendency to pull one back to the past trauma(s) and ineffective coping. Reflecting back on my own personal experience, the medication at the time had its place. I was on Serzone, Prozac, Depakote, Seroquel, Klonopin, and Desyrel. It was the only thing that "glued" me together at the time. Like CharlieRN said, there is no magic pill out there. Doubt there ever will be. Medication has its place...which med(s)?...it really depends on the persons symptom picture, the acuity of symptoms, and the degree of suffering. I'm not a real big fan of Benzodiazepine use either. I used to work detox. Xanax withdrawal can be real nasty. Mood stabilizers, anti-depressants, and yes, anti-psychotics have their place if the patient benefits from their use. Hope this helps.

krisssy · Jul 31, 2005

What is interesting about this (PTSD and meds vs/and counseling) is that counseling can often become ineffective IF the person is in acute states of their illness. During these times, meds may become the only answer to relieving the symptom picture. When the sufferer is in acute distress, mentally/emotionally attending to therapy/counseling may be very difficult for the patient...if not down right frustrating. The counselor's theoretic approach to counseling also is a factor. There was one medical article I read many months ago (I forget which) that concluded that counseling for PTSD was not found to be very effective as a form of treatment. Again, this was one article...and I believe it referred to counseling approaches that focus on going back to the trauma in order to heal. In this sense, I probably would agree. Being retraumatized in therapy is not very therapeutic. For PTSD sufferers, therapy/counseling needs to be a safe, grounding experience. As an ex-counselor and as a PTSD sufferer (in much of his remission at present), the counseling approach which appears to help was very reality based, "present" and trigger/symptom focused, understanding one's symptoms for what they were, and addressed one's coping for living in the present despite the mind-body's tendency to pull one back to the past trauma(s) and ineffective coping. Reflecting back on my own personal experience, the medication at the time had its place. I was on Serzone, Prozac, Depakote, Seroquel, Klonopin, and Desyrel. It was the only thing that "glued" me together at the time. Like CharlieRN said, there is no magic pill out there. Doubt there ever will be. Medication has its place...which med(s)?...it really depends on the persons symptom picture, the acuity of symptoms, and the degree of suffering. I'm not a real big fan of Benzodiazepine use either. I used to work detox. Xanax withdrawal can be real nasty. Mood stabilizers, anti-depressants, and yes, anti-psychotics have their place if the patient benefits from their use. Hope this helps.

From my personal experience, you are so right on the mark. The therapy I had was just traumatizing me more at the time. I was crying and hysterical 24/7. This horrible therapist that I was going to actually said to me, "Are you pretending or is this behavior for real?" That was the last time I went back for therapy, and that was a few years ago. Then I had the psychiatrist who gave me large doses of Xanax. Being given the Xanax was a complete disaster as I already described. Finally I found another psychiatrist who prescribed Zyprexa which calmed me down enough to function. I am now off that and functioning pretty well considering the trauma and how my psyche and body reacted to it. It happened four years ago. It took two years to even begin recovering. At this point I am doing very well all things considered. I do get a mind/body reaction that pulls me back to the trauma exactly how you described, amd when it hapoens I do revert back to the ineffective coping mechanisms. I feel that I am finally ready to begin therapy that will focus on these issues of what is happening to me presently. I have put off calling this new therapist that I had gone to once and had to stop due to surgery. I am definitely going to call her next week. I just want it to be all over. But I can see that although the hysteria, major depression and severe anxiety is gone, there are still triggers that bring back some symptoms but to a much lesser degree. Anyway, I just wanted to really say that I agree with you completely about the possibility that therapy may not work in the acute stages of PTSD, and that benzodiazapams are not a very good idea.

krisssy · Aug 1, 2005

ELKMNin06 I was wondering how you are doing with your paper. I would be careful with the benzodiazapams. If you use them, I would suggest discussing the problems re. addiction. As someone stated, coming off them is murder. And if you suggest using them PRN, you have to take into consideration whether the person is in a state to only use them PRN. Also, does the patient have any history of substance abuse? Just some things I would bring up in the paper if I decided to use them for PTSD. Personally, I would have done the paper on antipsychotics and SSRI's. But that is probably personal, because that is what worked for me. and as I told you, I got addicted to Xanax and blacked out and overdosed from them. I think your prof. gave you a great assignment. I would love to see your paper when you are finished and what your prof thinks. I am really interested in this because of personal experience and because I will be starting a psychiatric nurse practitioner's program in the spring. good luck to you. Krisssy