Finding The Right PTSD Medication For You
By Nadia Khan
Updated December 19, 2018
Reviewer Laura Angers
Post-Traumatic Stress Disorder (PTSD) affects millions of Americans with symptoms that dramatically impact jobs, relationships, and other crucial aspects of day-to-day life.
Similar to other mental illnesses, like anxiety and obsessive-compulsive disorder, the full picture of PTSD is a complex one that includes biological, psychological, and social components.
The brain of a person living with PTSD shows marked differences from that of a person who does not have this disorder. Brain imaging shows that they have increased activity in the amygdala, the part of the brain that controls our "fight or flight" impulse when faced with danger. It also shows that this part of the brain is no longer well integrated with the prefrontal cortex, the part of the brain responsible for rational thinking and judgment.
This altered brain structure at least partially explains the four symptom clusters which the DSM-5 classifies as part of its criteria for making a diagnosis of PTSD:
- The sufferer re-experiences the traumatic event through nightmares, physical reactivity, intrusive thoughts, and flashbacks. In children, this may be expressed through violent, repetitive play.
- The sufferer avoids any trauma-related stimuli. That includes external reminders (such as specific places, conversations, or objects) and internal reminders (thoughts and feelings).
- Increased negative thoughts or feelings. The person may embrace negative beliefs about the event in which blame for self or others is distorted. He or she might also demonstrate excessively negative beliefs about the world or himself or herself. These negative feelings may be persistent, and the person may even seem unable to experience positive feelings.
- Changes in arousal symptoms. The sufferer will be "on edge" and watchful, and shows symptoms like irritability, increased anger, difficulty concentrating, and hypervigilance. He or she startles easily.
If you are suffering from these symptoms following a traumatic event, it's easy to understand that your day-to-day life and your ability to function could be severely compromised. That's why you have probably concluded that it's time to get some help.
Treatments For PTSD
Successful treatment for PTSD depends, in large part, on the individual. Many factors influence the success of your treatment.
According to the VA/DoD Clinical Practice Guidelines for 2017, the best first-line treatment for PTSD is cognitive therapy. Based on research, it has been found to be most effective in treating symptoms of the disorder. Specific types of therapy, such as Prolonged Exposure and Cognitive Processing Therapy, have been shown to have the most success.
If you are ready to get started with cognitive therapy to help with your PTSD symptoms, Better Help is a great place to start. We have therapists on staff that is professionally trained in effective strategies in the management of PTSD symptoms.
But sometimes, symptoms can be so severe that they interfere with the therapy process itself. Effective therapy often requires "talking through" or reliving the trauma in some way, and this experience may be difficult or even impossible for some people living with PTSD. In cases like these, the right meds for PTSD can ease symptoms enough to reap the benefits of cognitive therapy.
Things To Consider
The decision to medicate or not to medicate is complicated. And even more complicated is the decision about which medication to try.
Starting a new medication can be scary. You don't know what it's going to do to your body. You're taking a gamble that the benefits will outweigh any unknown problems that might arise.
But if you're here reading this, I'm guessing you already know that it's time to take action and that therapy alone may not be enough.
If you have made that decision, I want to congratulate you. You have taken a huge step in the process of getting better.
And because knowledge is power, here are some things to think about as you contemplate your next step in determining which medication for PTSD may be right for you.
- Do you have any other disorders besides PTSD (i.e., panic disorder, major depressive disorder, etc.) which could be helped with medication?
- Are you prepared to handle some bothersome and (hopefully) temporary side effects on the road to recovery?
- What was the nature of the traumatic event that triggered your PTSD symptoms?
- Have you tried medication before, and what was your experience like?
- Do you have any health conditions which may contraindicate the use of some medications (i.e., hypertension, pregnancy, etc.)?
- Do you drink alcohol regularly or use any illicit recreational drugs that might interact with medications?
- Which PTSD symptoms are bothering you the most?
- What is your ultimate goal for recovery?
Thinking about these questions before talking to your doctor can help you articulate your ideas about the kind of medication that would be most helpful in your specific situation.
Types Of PTSD Medication
Many different types of medication may be used in the treatment of PTSD. Many of these are the same that have proven effective in treating other illnesses, such as anxiety disorder and depression. Here we'll provide a description of the broad categories and some of the specific medications that might be used, along with their pros and cons, to help you make a better decision, with the help of your doctor.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Traditionally, this class of medicine has been the first line of defense in treating any mood or anxiety disorder, including PTSD.
It works by correcting problems with the transport of serotonin in the brain. This is a problem resulting from increased activity in the amygdala (mentioned earlier).
Currently, only two SSRI medications (sertraline and paroxetine) are FDA-approved for the treatment of PTSD. However, other medications can be prescribed "off-label" if the individual situation warrants it.
Unfortunately, not every patient finds success in using SSRIs to treat PTSD. Some patients find that the side effects (which range from headaches to sexual dysfunction to suicidal ideation) are just too tough to take. Not everyone experiences these side effects, though. You may find that any side effects are mild in comparison to the relief that these medications offer. For those who can tolerate them, SSRIs can be a lifesaver. Studies have shown that 60% of patients find relief from their symptoms by using them. They are especially helpful in patients who have co-occurring disorders involving anxiety, panic, and depression.
If you are prescribed an SSRI, keep in mind that it can take 6-8 weeks for it to begin to work so that patients will be necessary. The research is clear that patients do better if they continue taking a prescribed medication for at least a year.
The following SSRIs are commonly prescribed for PTSD.
- Sertraline (Zoloft). This medicine is also helpful in treating social anxiety, panic disorder, and obsessive-compulsive disorder, all of which can co-occur with PTSD. It has been found to have the greatest success with survivors of physical or sexual assault. The recommendation is 50 to 200 mg daily.
- 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 in the treatment of depression, panic disorder, obsessive-compulsive disorder, and social anxiety. The recommended dosage is 20 to 60 mg daily.
- Fluoxetine (Prozac). The use of Prozac for PTSD is "off-label" and results of its success as a treatment for this disorder are still inconclusive. But Prozac may be prescribed in some cases when Zoloft or Paxil seem ineffective.
- Venlafaxine (Effexor). This does not fall strictly into the category of an SSRI: rather, it is an SNRI (serotonin-norepinephrine reuptake inhibitor). It works similarly as the SSRIs, but with the difference that it inhibits the reuptake of norepinephrine in addition to serotonin. For this reason, some patients may find it more effective than the SSRIs.
Monoamine Oxidase Inhibitors (MAOIs)
These medications work by blocking the removal of norepinephrine, serotonin, and dopamine from the brain. Although they have been shown to be highly effective in the treatment of PTSD and other depressive disorders, they are not usually the first line of defense due to safety issues and severe side effects. But if SSRIs are not working, and side effects (especially blood pressure) are closely monitored, MAOIs can be helpful to treat PTSD in some people.
At this time, the only MAOI currently recommended for the treatment of PTSD is phenelzine (Nardil). Patients who take this medication have experienced a reduction in some symptoms like avoidance, flashbacks, nightmares, and insomnia. However, they show little improvement in other areas. The medicine also has potentially fatal consequences for hypertension and can interact dangerously with alcohol and some illegal drugs.
These medications work by blocking norepinephrine at the brain synapses and blocking adrenaline from entering organs such as the muscles and the heart. They are helpful primarily in reducing hyperarousal and aggression. They can also reduce the severity of some co-occurring disorders, like social anxiety.
The medication most commonly used in PTSD patients is propranolol. Although not FDA-approved for this use, it has been found to help reduce explosive anger, exaggerated startling, intrusive flashbacks, and nightmares.
These medications work by enhancing the activity of the GABA receptor, a neurotransmitter in the brain which slows down and calms the central nervous system.
These medications should be used with caution, as they have the potential for addiction. They can also cause mental clouding which can make it difficult to integrate the traumatic experience, hindering therapy.
However, these medications can be used with close monitoring on a short-term basis for easing acute PTSD symptoms.
The most commonly prescribed benzodiazepines are:
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Diazepam (Valium) and
- Alprazolam (Xanax)
This medication is traditionally prescribed to treat hypertension, but some people living with PTSD have used it to find relief from nightmares and insomnia successfully.
Studies have shown that prazosin is effective in restoring normal sleep patterns for combat vets. However, research on its effectiveness for daytime PTSD symptoms is still inconclusive.
An Array Of Options
As you can see, there are many possible solutions for PTSD meds that work. Sometimes you might try a med just for a short time, and then switch to something else. In other cases, you might take more than one medication for PTSD and find that they complement each other, at least for a short time.
There is no one right answer for determining how to treat PTSD symptoms. But remember that your first line of defense is a good therapist who can help you work through your pain.
Medication for PTSD on its own may help temporarily, but seek ongoing help from a professional if your goal is long-term healing.