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When Therapy Just Isn’t Enough

Don’t give up.  Be honest. Don’t wait. This is the advice I have for anyone suffering from PTSD who isn’t seeing any improvement yet from their course of treatment.  Prescription medications are a viable and often times, beneficial augmentation to therapy.  Like therapy itself, it is something that takes time and must be tailored to the individual for maximum effect.

Don’t give up – because therapy, which is considered to be the best treatment for PTSD, doesn’t work overnight.  It takes time and effort, but in the end, it has a better track record for actually resolving the underlying problems causing your symptoms.

Be honest – with your physician about how you are feeling. Therapy really does work best to resolve your underlying issues, but some people suffering through PTSD might not be able to get the full advantage of those sessions because their emotional state is too fragile for anything to really sink in and help them.

It is in these cases that prescription medications can be a lifesaver.  It can lighten the proverbial load, and get you back into a place where your therapy sessions have a real chance to work.  It can be really difficult to admit, even to your doctor, how fragile or out of control you feel, but being honest about it is the only way your physician can gauge your state of mind and make the best recommendations for your treatment. Your course of treatment has to be a collaborative effort between you and your doctor.

Don’t wait – until your world is falling apart.  Bring your concerns to their attention as soon as possible because it is critical to your recovery.  Let them know if you’re not seeing any changes and things only seem to be getting worse.  Therapy takes time to work, but so do the medications often prescribed for treating PTSD.

Depending on the specific issues your doctor is trying to address with the prescription medications, it can take over a month for you to actually feel the effects.  So, if you wait until the last minute when you just don’t feel like you can hang on much longer, your relief with the medication may be another month or so coming, and that isn’t a place you want to be.

Medication Options

Prescription PillsMany doctors feel that PTSD is best tackled by a combination of therapy and medication.  While medication is not necessarily the recommended treatment for this diagnosis, other issues that often co-occur with PTSD, such as anxiety and depression, are diagnoses that can be effectively treated with prescription drugs.  What your physician prescribes will depend on your individual circumstances and the symptoms you are struggling to overcome.

Only two prescription medications have actually been approved by the FDA specifically as treatments for PTSD, and they both fall into the Serotonin Reuptake Inhibitors (SSRIs) category, which falls into what I loosely refer to as the “Blockers.”

Blockers, or Feel Good Medications:

These are drugs that work primarily by blocking receptors in your brain, causing the desired chemicals to remain in your brain chemistry longer.  Their purpose is to keep feel-good chemicals, such as serotonin, norepinephrine, or dopamine, in your blood longer, and some of them also increase the production of those neurotransmitters.

  • Serotonin Reuptake Inhibitors (SSRIs): This category of medication blocks the ports in your brain that reabsorb serotonin, which is a neurotransmitter that affects mood.  Sertraline and paroxetine, better known by their brand names Zoloft and Paxil, are the two recognized by the FDA as appropriate treatments for PTSD, while the VA/DoD Clinical Practice Guideline for PTSD also recognizes the efficacy of fluoxetine (brand name Prozac).
  • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Similar to SSRIs, SNRIs also block the reuptake of serotonin, but at higher dosages, they also prevent the reuptake of norepinephrine, another feel-good neurotransmitter. Venlafaxine (brand name Effexor) also has a decent reputation for treating PTSD symptoms, though still not FDA approved.
  • Mood Stabilizers: This category of drug helps to regulate mood fluctuations by blocking dopamine receptors, while also increasing serotonin production.
  • Antipsychotics: Similar to the mood stabilizers, this category of drug also works by blocking dopamine receptors, while some of the atypical antipsychotics block serotonin receptors as well.

Reducers:

Again, my loose terminology for those categories of drugs that work by slowing down some of the negative symptoms of PTSD, as opposed to increasing the feel-good chemicals.

  • Beta Blockers: Yes, this category is called a blocker, and it does work by blocking the effects of the hormone epinephrine (aka. Adrenaline), which results in a slower heartbeat that is less forceful, ultimately reducing blood pressure. So, while it is a blocker, it is working to reduce the adrenaline in your system and symptoms of anxiety.
  • Benzodiazepines: These drugs also work to reduce anxiety by slowing the central nervous system, resulting in relief of nervousness and tension. These may be prescribed for the treatment of anxiety, panic disorders, or difficulty with sleeping.
  • Prazosin: This category is also actually a blocker, but works to reduce your adverse symptoms. They are known as alpha-adrenergic blockers that relax your veins and arteries so that blood can travel more easily.  This is primarily used for treating hypertension but has been prescribed for PTSD symptoms as well, especially for those suffering from insomnia or nightmares.

There are a number of other anti-depressant medications, such as tricyclics and MAOIs, that can also treat some of the symptoms of PTSD, but they are prescribed less often, and usually only when the other preferred medications aren’t working, or when the side effects of the preferred options are particularly troublesome to the patient.  It is usually their side effects, their potential for becoming addictive, or potential to harm the body that makes them less attractive alternatives.

Even if you are skeptical about taking prescription medications to treat your symptoms, it is always worthwhile to have that conversation with your doctor, as they may have other recommendations for the specific symptoms you are facing.

If medication is what they recommend, remember my words of advice – don’t wait until your symptoms are ruling your life before trying something different.  Give them a try, continue communicating honestly with your physician about how you are feeling, and never give up.  The help you need is out there, even if it isn’t a magic pill that takes effect immediately.

Don’t give up on yourself or your treatment.

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