How To Choose An Effective PTSD Treatment
Post-traumatic stress disorder (PTSD) affects millions of Americans with symptoms that adversely impact work, relationships, and daily life. PTSD can be complex and includes biological, psychological, and social components. The condition is often treated with talk therapy or medication. If you're looking to decide which type of PTSD treatment is most effective for you, there are a few options to consider.
The effects of PTSD
The brain of a person with PTSD shows marked differences from a person without the condition. For example, brain imaging shows increased activity in the amygdala, the brain area controlling the fight or flight impulse when faced with danger. Brain imaging also shows changes in how the amygdala is integrated with the prefrontal cortex, the brain region responsible for rational thinking and judgment.
This altered brain structure partially explains the four symptom clusters that The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes as criteria for a PTSD diagnosis, including the following:
- Re-experiencing symptoms: Re-experiencing the traumatic event through nightmares, physical reactivity, distressing memories, and flashbacks
- Avoidance symptoms: Avoiding trauma-related stimuli, including external reminders, such as specific places, conversations, or objects, and internal reminders, such as thoughts and emotions
- Cognitive symptoms: Unwanted thoughts or feelings, such as blaming oneself. The person might also demonstrate negative attitudes about the world or others
- Arousal symptoms: Changes in arousal levels, such as feeling on edge, irritability, increased anger, difficulty concentrating, hypervigilance, or easy startle
Without treatment, some people’s symptoms may gradually lessen, while others may experience worsening symptoms or even physical medical problems, like hypertension.
Psychotherapeutic treatments for PTSD
Successful treatment for PTSD may depend on the individual. However, a few factors may influence the success of treatment.
According to the US Department of Veterans Affairs, the most effective first-line treatments for PTSD are cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR). Other therapies for PTSD may include prolonged exposure therapy and cognitive processing therapy (CPT).
In some instances, symptoms may be so severe they interfere with psychotherapy. Effective therapy often requires "talking through" or "remembering" traumatic memories, and this experience may be difficult or impossible for some people. In cases like these, medications might ease symptoms enough to reap the benefits of cognitive therapy.
However, consult your mental health and medical team before starting, changing, or stopping a medication.
Questions to consider about PTSD medications
The decision to medicate or not can be complicated because there are various medications on the market, and each one has potential side effects to discuss with your doctor. In addition, starting a new medication can be scary, and you may be taking a risk to see whether the benefits outweigh any adverse effects.
The following questions can be considered as you contemplate which PTSD medication may be effective for you alongside your doctor's advice:
- Do you have other mental health problems besides PTSD, like panic disorder or major depressive disorder, that medication might treat?
- Are you prepared to handle potential side effects on the road to recovery?
- Have you tried medication before, and what was your experience?
- Do you have any health conditions that may contraindicate using some medications, such as hypertension or pregnancy?
- Do you drink alcohol regularly or use any illicit recreational substances that might interact with medications?
- Which PTSD symptoms are bothering you the most?
- What is your goal for recovery?
Thinking about these questions before talking to your doctor can help you articulate your concerns about the type of medication that might be most helpful in your situation.
Types of PTSD medications
Doctors can prescribe various medications for PTSD symptoms. Many of these are the same that have proven effective in treating other mental health problems, such anxiety disorders and depression. Below are a few broad categories and specific medications that might be used, along with their pros and cons, to help you make a better decision alongside your doctor.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are often the first line of defense in treating mood or anxiety disorders, including PTSD. This medication may work by altering serotonin transport in the brain, which plays a central role in mood control. Currently, the SSRIs sertraline and paroxetine are the only ones approved by the FDA for the treatment of PTSD. However, doctors can prescribe other medications off-label if the situation warrants it. This means that there’s insufficient evidence for the FDA to approve it for that purpose, but there is guideline development panel consensus that the medication is generally safe and effective for the condition.
Not every client may experience success using SSRIs to treat PTSD. Some might experience side effects, which can be challenging. Side effects can include headaches, sexual dysfunction, and suicidal ideation. Doctors may also prescribe a similar type of medication called serotonin norepinephrine reuptake inhibitors (SNRIs), which benefits from combined serotonin reuptake inhabitation and norepinephrine reuptake inhibition. These can be more effective than SSRIs, but they tend to cause more side effects.
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Not everyone experiences these side effects, and adverse effects might be mild compared to the relief these medications offer. Studies have shown that 60% of clients find some relief from their symptoms by using them. However, only 20% to 30% achieve complete remission using medication alone. In addition, if you decide to take an SSRI, remember that it can take six to eight weeks for the medicine to begin working.
Doctors commonly prescribe the following SSRIs for PTSD:
- Sertraline (Zoloft): This medicine may also be used for social anxiety disorder, panic disorder, and obsessive-compulsive disorder, which can co-occur with PTSD.
- Paroxetine (Paxil): Besides affecting serotonin reuptake, Paxil has the added benefit of a slight effect on norepinephrine and dopamine, which can also affect PTSD symptoms. In addition to PTSD, it has been approved for treating depression, panic disorder, obsessive-compulsive disorder, and social anxiety.
- Fluoxetine (Prozac): The use of Prozac for PTSD is off-label, and the results of its success as a treatment for this disorder are still inconclusive. However, fluoxetine may sometimes be prescribed when other medications are ineffective.
- Venlafaxine (Effexor): This medicine does not fall strictly into the category of SSRI. Instead, it is an SNRI (serotonin-norepinephrine reuptake inhibitor). It works similarly to SSRIs. However, venlafaxine acts primarily by inhibiting the reuptake of norepinephrine in addition to serotonin.
Monoamine oxidase inhibitors (MAOIs)
MAOI medications work by blocking the removal of norepinephrine, serotonin, and dopamine from the brain. They are sometimes prescribed for anergic bipolar disorder, atypical depression, depression to is resistant to other medications, and PTSD. Although they can effectively treat PTSD and depressive disorders, they are not often the first line of defense due to safety issues and severe side effects. However, if SSRIs are not working and side effects like high blood pressure are closely monitored, MAOIs can be helpful for some people with PTSD.
The only MAOI that may be recommended for the treatment of PTSD is phenelzine. Some clients who take this medication experience reduced symptoms like avoidance, flashbacks, nightmares, and insomnia. However, they show a slight improvement in other areas. The medicine may cause hypertension and can interact dangerously with substances, so consult a doctor before using it.
Beta blockers
Beta-blockers block norepinephrine at the brain synapses and block adrenaline from entering organs such as the muscles and the heart. They might help reduce hyperarousal and aggression. They can also improve symptoms of severe anxiety.
The beta blocker medication most used for PTSD is propranolol. Although not FDA-approved for this use, it has been found to help reduce explosive anger, exaggerated startling, intrusive flashbacks, and nightmares.
Counseling options
Many medications offer support for clients experiencing PTSD or co-occurring mental illnesses. In some cases, a doctor might ask their client to try a prescription for a short time and then switch to another. In other cases, doctors prescribe more than one medication for PTSD and find they can complement each other.
There is no single answer for treating PTSD symptoms, and medications can help temporarily. However, remember that a compassionate and qualified therapist can be crucial in helping you overcome the physical, emotional, and social symptoms of PTSD. Often, medications are short-term, whereas therapy can have long-term impacts. A therapist can also help you determine if medications are reasonable options, although only a doctor or psychiatrist can prescribe them.
If you're worried about attending therapy due to the cost, distance, or availability, you might also benefit from online counseling. Research shows that online therapy can be effective in treating PTSD. PTSD symptoms include anxiety symptoms that might be easier to manage when talking to a therapist through an online platform. In addition, online therapy has the benefit of being easy to reach from home or any other location with internet connectivity, which can make a significant difference for people with PTSD.
If you're interested in getting started, you can work with an online platform like BetterHelp, which has over 30,000 licensed therapists, counselors, and social workers specializing in various areas of mental health, including PTSD.
Takeaway
What is the best medication for PTSD?
According to the American Psychological Association, the medications with the strongest evidence base are selective serotonin reuptake inhibitors. Treating PTSD with a selective serotonin reuptake inhibitor may reduce PTSD symptoms more effectively than other medications. These medications may help to regulate the neurotransmitter serotonin and, in some cases, norepinephrine as well.
How can I reduce my PTSD anxiety?
Reducing PTSD-related anxiety involves a combination of strategies to manage and improve symptoms and improve your overall well-being. Here are some techniques that can help:
- Seek Professional Help: Consult a mental health professional who specializes in trauma and PTSD treatment. They can provide personalized strategies and other treatments or therapies to manage your anxiety.
- Practice Relaxation Techniques: Engage in deep breathing exercises, progressive muscle relaxation, or mindfulness meditation to help calm your mind and body when anxiety flares up.
- Structured Routine: Establish a daily routine that includes regular sleep, healthy meals, exercise, and relaxation. A structured routine can provide a sense of stability and predictability.
- Limit Triggers: Identify and minimize exposure to triggers that worsen your anxiety. Gradually facing triggers in a controlled manner with the guidance of a therapist can help desensitize their impact over time.
- Cognitive Behavioral Therapy (CBT): Work with a therapist trained in CBT to challenge and reframe negative thought patterns that contribute to your anxiety. CBT can help you gain a more balanced perspective.
- Mindfulness and Grounding Techniques: Practice staying present in the moment through mindfulness. Grounding exercises, such as focusing on your senses or using tactile objects, can help you stay connected to the present and reduce anxiety.
- Support Network: Connect with supportive friends and family members, or engage in group therapy with those who understand your struggles and can provide a listening ear.
- Limit Stimulants: Reduce caffeine and alcohol intake, as they can exacerbate anxiety symptoms.
- Physical Activity: Engage in regular physical exercise, as it can help reduce anxiety by releasing endorphins and promoting relaxation.
- Healthy Coping Strategies: Develop healthy ways to cope with stress, such as journaling, engaging in hobbies, spending time in nature, or creative activities.
- Distraction Techniques: Engage in activities that capture your attention and distract you from anxious thoughts, such as reading, puzzles, or artistic pursuits.
- Progressive Exposure: Gradually expose yourself to anxiety-provoking situations related to your trauma in a controlled and supportive environment. This can help you build resilience over time.
- Medication: Consult a psychiatrist to discuss whether medication, such as antidepressant medications or anti-anxiety medications, might be beneficial in managing your anxiety.
How do you deal with PTSD?
Dealing with PTSD involves a multi-faceted approach tailored to your individual needs. Seeking professional help from therapists experienced in trauma and traumatic events is crucial. Therapies like Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), or exposure therapy are effective treatments that can help you process the trauma, challenge negative thought patterns, and develop coping strategies.
It also may be important to prioritize self-care: establish a consistent routine, ensure adequate sleep, eat nutritiously, and engage in regular exercise to support your overall well-being. Mindfulness practices, relaxation techniques, and grounding exercises can help manage anxiety and stress. Building a strong support network of friends, family, and support groups can provide emotional validation and a safe space to talk about experiences.
Be patient with yourself; healing from PTSD takes time, and setbacks are normal. Focus on gradual progress, celebrate small victories, and remain open to trying various strategies until you find what works best for you.
What is the first medication for PTSD?
Selective serotonin reuptake inhibitors (SSRIs) are typically the primary treatment option when it comes to medication for PTSD. SSRIs help to manage the level of brain chemicals called neurotransmitters, such as serotonin or norepinephrine. There is strong evidence that SSRIs are effective at treating PTSD, however, they may also be part of a broader treatment plan that includes therapy, self-care, and other forms of treatment.
What triggers PTSD?
Post-Traumatic Stress Disorder (PTSD) can be triggered by various stimuli that remind individuals of their traumatic experiences. Triggers are external cues that evoke strong emotional or physical reactions, often leading to the re-experiencing of trauma. Common triggers for PTSD include:
- Sensory Cues: Any sensory input resembling aspects of the traumatic event, such as certain sounds, smells, tastes, or textures, can trigger flashbacks, distressing memories, or intense emotions.
- Similar Situations: Being in situations or environments that resemble the place or circumstances of the trauma can trigger anxiety and distress.
- People: Seeing someone who reminds the individual of the traumatic event, or encountering individuals involved in the event, can trigger strong reactions.
- Sounds: Sudden noises or sounds that were present during the trauma can trigger fear or distress.
- Visual Cues: Witnessing something that resembles aspects of the trauma, even indirectly, can trigger memories or distress such as seeing a serious injury.
- Smells: Specific odors associated with the trauma can trigger emotional reactions and vivid memories.
- Physical Sensations: Physical sensations, such as touch or temperature, that were present during the traumatic event can evoke memories and anxiety.
- Emotional States: Experiencing emotions similar to those felt during the trauma, even if unrelated to the current situation, can trigger distress.
- Anniversary Dates: The anniversary of the traumatic event can trigger emotional responses and memories associated with it.
- News or Media: News stories or media content that remind the individual of the trauma can trigger distress.
- Conflict or Confrontation: Situations involving conflict or confrontation can trigger feelings of anxiety and distress, especially if they resemble aspects of the traumatic event.
Can you recover from PTSD?
Yes, many individuals with Post-Traumatic Stress Disorder (PTSD) can experience significant improvement in their symptoms and quality of life through appropriate treatment and support. Recovery from PTSD involves managing and reducing the intensity of symptoms, improving overall well-being, and developing effective coping strategies. While not everyone may fully "recover" in the sense of eliminating all symptoms, many people can achieve a level of healing that allows them to lead fulfilling lives.
Treatment options, such as therapy (Cognitive Behavioral Therapy, EMDR, etc.), medication, and support networks, play a crucial role in the recovery process. Practicing self-care, maintaining a healthy lifestyle, and learning to manage triggers and stressors can contribute to long-term improvement. The journey to recovery may involve ups and downs, but with time, persistence, and the right resources, many individuals can learn to effectively manage their symptoms and regain a sense of control, resilience, and well-being.
How do doctors treat PTSD?
Doctors treat Post-Traumatic Stress Disorder (PTSD) after a patient has experienced trauma, through a combination of therapeutic approaches, medications, and supportive interventions. Here are some common methods doctors use to treat PTSD:
- Cognitive Behavioral Therapy (CBT): This structured therapy helps individuals recognize and challenge negative thought patterns related to the trauma. Exposure therapy, a form of CBT, gradually exposes patients to trauma-related memories and triggers to reduce their emotional impact.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR combines exposure therapy with guided eye movements to help patients process traumatic memories and reduce distress.
- Trauma-Focused Therapy: Therapists address trauma-related symptoms and distress through various techniques, tailored to the individual's needs.
- Medications: Antidepressant medications like Selective Serotonin Reuptake Inhibitors (SSRIs) can help manage symptoms such as depression, anxiety, intrusive thoughts, and other symptoms. A doctor may try a dosage for a few weeks to see how symptoms are impacted.
- Supportive Therapy: Doctors provide emotional support, psychoeducation about PTSD, and guidance on managing symptoms and triggers.
- Mindfulness and Relaxation Techniques: Practices like mindfulness meditation, deep breathing, and progressive muscle relaxation can help patients manage anxiety and stress.
- Group Therapy: Group therapy sessions offer a supportive environment for individuals to talk about experiences, learn coping skills, and gain a sense of community.
- Lifestyle Changes: Encouraging patients to adopt healthy habits like regular exercise, proper sleep, and a balanced diet can contribute to overall well-being.
How can PTSD be treated without medication?
Post-Traumatic Stress Disorder (PTSD) can be treated effectively without medication through various therapeutic approaches and self-care strategies. Here are some non-medication treatments for PTSD:
- Cognitive Behavioral Therapy (CBT): CBT focuses on changing negative thought patterns and behaviors associated with the trauma. Exposure therapy and cognitive restructuring are common CBT techniques.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR involves processing traumatic memories through guided eye movements or other forms of bilateral stimulation.
- Trauma-Focused Therapy: Specialized therapies like prolonged exposure therapy and cognitive processing therapy specifically target trauma-related symptoms.
- Mindfulness and Relaxation Techniques: Mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help manage stress and anxiety.
- Support Groups: Participating in support groups with others who have experienced trauma can provide validation, a sense of belonging, and opportunities to learn from others.
- Art and Expressive Therapies: Creative outlets like art, music, dance, or writing can help process emotions and experiences in a nonverbal way.
- Yoga and Physical Activity: Engaging in regular physical exercise or trauma-informed yoga can reduce stress, improve mood, and promote relaxation.
- Grounding Techniques: Techniques that help you stay present in the moment, such as focusing on your senses or using tactile objects, can reduce anxiety and dissociation.
- Self-Care and Lifestyle Changes: Prioritize self-care through proper sleep, a balanced diet, regular exercise, and activities that bring you joy.
- Coping Strategies: Develop healthy coping strategies to manage stress and triggers, such as journaling, practicing gratitude, or engaging in hobbies.
- Education and Psychoeducation: Learning about PTSD, its symptoms, and coping strategies can empower you in your recovery journey.
- Structured Routine: Establishing a daily routine can provide a sense of stability and predictability.
While medication isn't the only option, it might be considered in cases where symptoms are severe or significantly impacting daily functioning. Consulting with a mental health professional to create a personalized treatment plan tailored to your needs and preferences is crucial for effective management of PTSD.
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