So how can you treat PTSD?
First line defence is using an SSRI, a
selective serotonin reuptake inhibitor.
This acts by preventing the reuptake
of serotonin in presynaptic neurons.
Thereby increasing the amount
of serotonin in synapses.
These medications take about four to
six weeks to reach maximum efficacy
and some side effects to look out for
included their black box warning,
stomach upset, sexual dysfunction,
night sweats and mood swings.
When it comes to that
black box warning,
what this is is a hazard warning issued by
the FDA, the Food and Drug Administration.
And it explains that SSRIs are
associated with an increased risk
of suicidal thinking, feeling,
and behavior in young people.
And it’s very important to monitor
patients on SSRIs for any mood shifts
or changes in their thinking, particularly
any dangerous thoughts of behaviors.
You might also try using other
antidepressants for a patient with PTSD,
such as a tricyclic
antidepressant and MAOI
or other second generation
antipsychotics can even be very helpful,
medications like quetiapine.
Therapy is also very useful
and should always be used along
with medication therapy.
CBT, cognitive behavioral therapy has a
lot of efficacy and proven benefits.
And also relaxation, support groups
and family therapy are very useful.
Note early treatment of PTSD
may prevent its chronicity.
Drug therapies have generally
been most effective
in decreasing hyperarousal
and mood problems.
So keep that in mind when
determining your management plan.
And also note that SSRIs
should always be started
at the low end of the
and they can always be
gradually titrated up.
Some other medication to consider include
alpha-adrenergic receptor blockers,
medications such as prazosin.
These help to reduce nightmares and
improve sleep in the patient with PTSD.
You want to start prazosin
at a very low dose
such as 1 mg and then gradually titrate
it upwards depending on tolerability.
And one of the things this medication
can do is alter the blood pressure.
So you do want to pay close
attention to side effect
and make sure that patient is
stable before making dose changes.
Hypotensive patients or those
prone to orthostatic hypotension
should be treated for this
reason very, very cautiously.
Another medication that can be used to treat
hyperarousal are the benzodiazepines.
However, these are used very cautiously
because they do have a
high addiction potential.
Exposure therapy that relies
on extinction learning
can also be extremely helpful
to the PTSD patient.
And as another important note because
you want your patient to very safe,
we’ll reiterate this point
given the high prevalence of
comorbid substance abuse
in patients with PTSD.
Benzodiazepines should be used very,
very sparingly and very cautiously.
They can also cause drowsiness and
sedation, which could be undesirable.
So in addition to addiction, the
benzodiazepines are not considered first line
because of their side effects
and abuse potential.
I want to take a moment
to point out the
difference between acute
stress disorder and PTSD.
Acute stress disorder is when a patient
experiences a major traumatic event,
but has anxiety symptoms for only
a very short duration of time.
To qualify for this diagnosis, the symptoms
must occur within one month of the trauma
and lasts for a maximum of
one month, but not beyond.
These symptoms are very
similar to those for PTSD.
So what does this statement apply to?
Acute distress disorder versus posttraumatic
stress disorder, here’s a little quiz.
An event that occurred
any time in the past.
Well, that can be posttraumatic
For acute stress disorder, remember
it has to have been within one month.
Making that the correct answer
to the second question.
And then when the symptoms last for less
than one month and then anxiety goes away,
it’s acute stress disorder.
When the symptoms last
more that one month,
we’re now talking about
posttraumatic stress disorder.
So that’s an overview of PTSD, a
pretty common anxiety disorder,
one that is very treatable, but also can
be extremely disabling for patients.
So very important to screen for
in any one who has been exposed to any
kind of trauma or life-threatening event
where they felt like themselves or loved one
was at risk for bodily harm and injury.
So now you know a little bit about the
diagnosis and also some treatment options.