PTSD: Medications and Therapy (Nursing)

by Brenda Marshall, EdD, MSN, RN

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      Slides Posttraumatic Stress Disorder Nursing.pdf
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    00:01 There are medications that we use to help people deal with their PTSD.

    00:09 So there are some SSRIs, antidepressants that we use.

    00:14 Prozac is one of the best medications also known as fluoxetine.

    00:21 Sertraline (Zoloft), and Paxil, which is a paroxetine.

    00:28 So, these are usually our first go to medications, if a person has PTSD.

    00:35 It helps with the anxiety, it helps with a depression.

    00:38 It really gives them an overall sense of capacity.

    00:44 And when I am talking about medications medications alone are not what's helping the person with PTSD or any other psychiatric disorder.

    00:55 Medications are an adjunctive used with therapy and other interventions, whether it's milieu therapy, whether it's group therapy, individual therapy, family therapy, or all of the above.

    01:13 Other antidepressants are also used to help patients who have PTSD.

    01:20 Nefazodone also known as Serzone Venlafaxine, which is Effexor.

    01:28 Remeron which is mirtazapine.

    01:32 And also the tricyclic antidepressants, and MAOIs are also used.

    01:40 Important to remember whenever medications are being used with a person with PTSD is to do patient education about what to expect, when they're taking these medication.

    01:55 We know that with antidepressants, there is usually a 7 to 10 pound weight gain.

    02:02 For some people, this alone will make them far more depressed.

    02:08 But if they know that it is associated with the medication that they're taking, and that they can adjust their eating habits and their exercise patterns and keep that weight gain to a very minimum, they are far more likely to be successful both with their medication adherence, as well as with their therapy.

    02:32 Also, medications like Remeron can be extremely tiring.

    02:38 And so if a patient is put on Remeron talked to the patient about maybe taking that at night, rather than during the day.

    02:48 Most important if your patient is placed on MAOIs, you want to make sure that they know all the food and dietary restrictions that go along with those medications.

    03:06 To affect their reactions to being activated when their anxiety kicks in.

    03:16 We also use beta blockers.

    03:19 So we might be using prazosin which is Minipress, clonidine which is Catapres, Guanfacine which is Tenex and propranolol.

    03:32 Now, why and how did we figure this out to use a beta blocker in order to deal with PTSD.

    03:42 We know that prazosin (Minipres) is incredibly effective to help with nightmares and flashbacks.

    03:52 It helps to calm the nervous system, it brings down the blood pressure but it also helps that patient to be able to sleep and not have nightmares and flashbacks.

    04:05 Other medications that are used to help you who have PTSD are mood stabilizers.

    04:11 Many of our mood stabilizers are also anti-seizure drugs like Tegretol also with its generic name of carbamazepine, or Depakote which is divalproex, Lamictal which is lamotrigine, and also Topamax which is topiramate.

    04:34 Now, they are mood stabilizers, yes, but they also are anti-seizure drugs.

    04:41 And as anti-seizure drugs, they have a general impact on the brain, slowing everything down.

    04:50 There is an increase in weight gain.

    04:53 There's an increase in likelihood for metabolic syndrome at some of these medications.

    04:59 And so we have to really be looking at our patient, the whole patient and weighing with the team, what is best for this person? And what is going to help them through to recovery from PTSD? In some cases, second-generation antipsychotics are used for persons who have PTSD.

    05:26 (Abilify) aripriprazol.

    05:30 Now, when we're looking at the antipsychotics, it's also important to remember that metabolic syndrome come secondary to the use of antipsychotics.

    05:43 In addition to that, we might be seeing some extrapyramidal symptoms.

    05:48 and so that patient might actually be put on other medications prophylactically, to prevent the extrapyramidal symptoms, something like Cogentin.

    05:59 And so we are starting to pile up and seeing a lot of medications being used for these sometimes difficult to treat patients.

    06:12 Benzodiazepines are also used with PTSD.

    06:16 Though not as frequently anymore, due to what we have seen with the explosion of substance use disorders secondary to medications that had been previously prescribed and over prescribed.

    06:32 So, for some people, benzodiazepine are being prescribed and that is lorazepam also known as Ativan, clonazepam which is Klonopin alprazolam which is Xanax, and diazepam which is Valium.

    06:55 These should be prescribed for short periods of time, and not over long periods of time because we know that with the benzodiazepines tolerance occurs.

    07:08 The patient will start requiring more in order to get the same effect, which will then lead them into possibly having a dependence.

    07:17 And then we have a completely different problem on our hand.

    07:24 So, there are other therapies.

    07:26 And as I said before, medication alone is not going to be our go to.

    07:31 We want to be able to help the patient towards recovery using a combination of strategies, medication, and therapy, and it may be more than one mode of therapy.

    07:44 The patient might have group therapy or family therapy.

    07:50 Cognitive behavioral therapy has been shown to be very effective for patients who have PTSD.

    07:58 Prolonged exposure therapy is a therapy that is used by the Veterans Administration with extremely good results.

    08:08 There is the eye movement desensitization and reprocessing therapy, also known as EMDR, which has also been demonstrated to be effective for persons with PTSD.

    08:22 And there is sensory motor psychotherapy.

    08:25 Again, specifically for people with trauma and attachment disorders.

    About the Lecture

    The lecture PTSD: Medications and Therapy (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Anxiety and Anxiety Disorders: GAD, Phobias, OCD, PTSD (Nursing).

    Included Quiz Questions

    1. Fluoxetine
    2. Sertraline
    3. Paroxetine
    4. Loratadine
    5. Diphenhydramine
    1. Medications should be used as an adjunct to other therapies.
    2. SSRIs are rarely used to treat PTSD.
    3. Antipsychotics are considered frontline treatment.
    4. Cognitive-behavioral therapy is not an effective treatment for PTSD.
    1. “Clients usually lose 10-15 pounds after starting an antidepressant.”
    2. “Some medications, like mirtazapine, can cause drowsiness and should be taken at night.”
    3. “Clients prescribed MAOIs should avoid wine, beer, and aged meat.”
    4. “Nefazodone can be used to treat PTSD.”
    1. It helps with nightmares and flashbacks.
    2. It helps with mood elevation.
    3. It helps counteract weight gain caused by other medications.
    4. It helps with agitation.

    Author of lecture PTSD: Medications and Therapy (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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