Symptoms, Medications for Post-Traumatic Stress Disorder

Post-traumatic Stress disorder (PTSD) is a mental illness that has received a great deal of media attention over recent years due to the growing number of former combat veterans diagnosed with it. As a group, soldiers returning home from Iraq and Afghanistan have been diagnosed in record numbers. Military service or exposure to war, violence, or natural disasters is not required in order to be diagnosed with PTSD; some people develop this disorder after repeated exposure to bullying, harassment, or abuse. In fact some researchers consider “battered women’s syndrome” to be a specific subtype of PTSD.

The main symptoms that medications for PTSD target are symptoms related to re-experiencing the trauma. These include nightmares, flashbacks, or thoughts or images that seem to push into your brain (called intrusive thoughts) when you are thinking of other things. These unwanted intrusive thoughts or images can be very disturbing and upsetting, and flashbacks can be completely terrifying, as you truly relive the traumatic event: sounds, smells, and everything. Medications may also target avoidance symptoms, which can include literal avoidance such as not going to the mall because there are too many people there, or emotional avoidance, which might look a lot like depression (sleeping excessively, not socializing, no longer doing things you used to enjoy, etc.). Lastly, there is a group of symptoms called “hyper-arousal” which include insomnia, paranoia, trouble concentrating, and feeling edgy, angry and irritable. Some medications aim to relieve these symptoms.

Antidepressants

The only medications that are specifically approved by the FDA to treat PTSD are a class of antidepressants called serotonin-specific reuptake inhibitors (SSRIs). These drugs, as a group, offer some real benefits compared to other medications that may be suggested as “off label” usage additions to treatment.

  • First of all, the SSRIs are not addictive and do not provide any “high” or sense of “quick relief” the way a sedative might. They work slowly over time, building up in the body before any relief is experienced. This is both a pro and a con, as a person struggling with intense flashbacks and severe re-experiencing symptoms might feel that the drug is doing nothing, at least at first.
  • SSRIs are reported to be effective in helping people with PTSD reduce their symptoms. Several studies published in well respected journals in the early 2000s report positive outcomes for people with PTSD who used either Zoloft or Paxil to treat their symptoms.
  • They are very safe substances, even in the case of overdose, and can be used by people whose moods are erratic and behavior might be unstable.
  • Selecting the correct SSRI is important, since there are a few different ones to choose from. These include Prozac, Zoloft, and Paxil, among others. Some are more sedating than others; some seem to help with anxiety more effectively, while others seem to be the best choice for managing avoidance.
  • Remember, the medications won’t cure PTSD or make it go away, but they can help ease the symptoms while you work in therapy.
  • Although many people tolerate SSRIs well with a minimum of side effects, some people have a tough time with a few common side effects. Stomach upsets are common, especially in the beginning, with nausea and diarrhea reported by some people. Sexual side effects (decreased libido and inability to climax) are reported by some people as well. Be sure to discuss any concerns you may have with your doctor and report any side effects as soon as you experience them.
  • SSRIs are not appropriate for everyone. Some people should not use these medications. Talk with your doctor to make sure you aren’t one of those people.

Mood Stabilizers

These medications are not FDA approved for the treatment of PTSD, but may be used “off label” to treat PTSD symptoms. These drugs include seizure medications including Tegretol, Depakote, and Topimax. Of the three, Topimax has shown the most promise in clinical trials, but has not yet been approved for use. In general, these medications can be trickier to use, as they do often come with more side effects and more need for monitoring (that means more frequent clinic visits and possibly regular blood tests to watch for any potential problems). They can also be toxic so overdose could be a concern. However, these medications are often prescribed for people with bipolar disorder. Some people with both PTSD and bipolar disorder have found that these bipolar meds have also helped their PTSD symptoms.

Antipsychotic Medications

Sometimes antipsychotic medications, such as Risperdal, Zyprexa, or Seroquel, may be suggested for PTSD. Antipsychotic medications, not unlike antidepressant medications, come in two major classes: the old ones and the new generation. The old ones are major tranquilizers such as haldol and Thorazine. These medications have a reputation for being powerful sedatives and creating “walking zombies.” The newer generation, medications such as Risperdal, Seroquel and Zyprexa, are touted for their effectiveness in reducing psychotic symptoms while having fewer side effects and allowing people using these medications to become more functional, not less.

That said, these medications can come with a stiff side effects price tag, and are currently seen as not effective enough to warrant the taking the risks. However, in those cases where you have a psychotic disorder as well as PTSD, and need treatment with an antipsychotic medication, some people report that these medications can also relieve PTSD symptoms as well as psychotic symptoms.

Sedatives

The last group of medications in this list consists of benzodiazepines—drugs including Valium, Xanax, Librium and Ativan. While some doctors will use these as rescue medications for severe anxiety they are not generally recommended for people with PTSD. These drugs work quickly and are thus described as “strongly reinforcing.” In other words, they are very addictive. When you’re tense and anxious you take one, and you feel a rapid sense of relief: sounds great, right? The problem is that your body develops dependence on these substances very quickly. Couple that with the psychological relief and it adds up to a dangerously addictive situation in a short period of time. Also, these medications are exclusively about short-term symptom relief—they don’t address the core symptoms of PTSD, but just help you check out for a while. In this way they support avoiding, which is something you don’t want to do as that just makes your symptoms worse. However, if you are experiencing panic attacks or severe anxiety along with your PTSD symptoms, your doctor may suggest one of these medications.