MEDICATION FOR PTSD

A number of different medications have been prescribed for PTSD.  These mostly include antidepressants. At times this can be helpful as chronic stress associated with PTSD can lead to depression that can be relieved, at least in part, by medication.  I say in part because if the stress connected to PTSD is ongoing then depressive symptoms can be precipiated again or never resolved with medication and therapy.  

Anxiety triggerd by events that remind the brain of past traumas is the main symptom of PTSD.  This anxiety is related to the almost instantaneous alarm response of the brain as it tries to avoid a catastrophic response.  It seems that frequent alarm reactions is better than being completely overwelmed.  Anything that can reduce the intensity of the anxiety response or reduce the frequency of anxiety responses will be helpful.  Medications targeting this have included propranolol, atypical antipsychotic medications and benzodiazepines.  Propranolol reduces the physical reactions to stress and thus can reduce the intensity and frequency of these reactions.  Atypical antipsychotic medications are also able to significantly reduce anxiety reactions and at lower doses are usually well tolerated without side-effects.  It may be difficult to explain why an antipsychotic medication is helpful and yet the intensity of the anxiety response in PTSD benefit from this type of medication. Benzodiazepines can temporarily reduce anxiety but often have side-effects and will over time be less effective.  There can also be dangerous withdrawal symptoms for the shorter acting benzodiazepines.

THE RIGHT DOSE OF MEDICATION FOR YOU

How do you know what is the right dose of medication?  I've already talked about the fact that doses are often established based on statistical averages.  This means that a percentage of people [32%] are more than one standard deviation above and below the mean.  These people will need doses that may not fit the usual dose range for a medication. Also, even if your dose is within the normal dose range, your specific dose is still important to determine as the success of the medication will depend on determining the optimal dose for you.  

So, what can you do to help your physician find the best dose of medication for you? You can write down symptoms you are having and check the internet to match your symptoms with specific diagnoses.  You can then share this information with your Doctor and then see which symptoms your Doctor feels are related to your diagnosis. Then you can keep track of the symptoms as you take the medication. You can then see if there is a dose that reduces or eliminates your symptoms.  If no dose is helpful, let your Doctor know so you can try a different dose until you find the right dose for you. Sometimes you might need to go down again with a dose and then raise it again to determine the best dose.  As a 23 year old patient of mine said recently: "I'm the best person to determine the optimal dose for me because I'm the only person who is me."  

The optimal doses of the vast majority of medications are based on the clinical response to the medication.  Your clinical response is what we've been talking about.  Your role in determining your response to medications is critical.  If your Doctor does not listen to your input regarding your response to medications, you may need to change Doctors.