PTSD MEDICATIONS
Yes this is LONG but it is just too important to blow off. The article this is based on is several pages longer though. Please if you or someone you care about is taking medications, at least take time to skim through this page. Ranger Mom
The following information can be seen in greater depth at the link at the end of this article.
Many a Vietnam Veteran has been treated not only with therapy, but also with medications. Although it goes without saying, medication is nothing to mess around with. It is the responsibility of the doctors perscribing the medications and your responsibility to be sure that NO MATTER how many doctors you see always be sure that ALL of the doctors know EXACTLY what and the dosage of all medications you are taking. Ask questions about drug interactions, and be sure that you understand fully. Do not assume you will just remember if there are very many, write it down, and put it where it is always easy to find.
The various drugs that are being used are like any medication some are good, some bad, and everyone will not react exactly the same as everyone else. For the safty of the rest of those living in your household, remember these are usually fairly hefty drugs. DO NOT leave them sitting out and accessible to others, particularly small children.
The following information taken from a article by Jonathan Shay, M.D., Ph.D. a psychiatrist, in the Boston, VA Outpatient Clinic..
PTSD is a moral, social, philosophical, and spiritual injury. The biological nature of human beings is to be moral, social, philosophical, and spiritual, so the injury also shows itself as medical disorders. Healing is psychological, social, spiritual and no medicine can cure combat PTSD. However, healing can never mean a return to a 17 year old innocence. Healing means building a good human life with others, a life that a veteran can embrace as their own."
The next time you are feeling like you should be able to just control this "thing" on your own, without help come back here and read this next line again..
"Combat trauma brings about long-lastintg changes in brain chemistry. We do not know whether these are permanent or can be reversed by psychological/social healing." In a nut shell IT ISN'T YOUR FAULT! And the next time you either accuse yourself or others accuse you of being a weak person who just can't handle it and needs to suck it up and go on, tell them to take a hike!
For the record..PTSD as it is called today, has a very long history. During the Civil War is was called "Exhaustion". During World War I it was called "Soldier's Heart". During World War II it was called "Shell Shock" at first and later "Combat Fatigue". In the 1980's it became officially labeled as PTSD, as described on the PTSD/DSM page of this site.
The objective is not to simply put you on a life time of medications and keep you drugged up and zombie like the rest of your life either. But there often is a time in the beginning when medications help to take the frantic edge and panic off so that you can then work on things and finally become strong enough to reclaim your life.
If you are taking medications, be sure that when you reach a point where they are no longer needed you do NOT suddenly stop taking them. Most all medications perscribed for you for PTSD need to be gradually withdrawn to help your body to navigate the removal of them from it's system safely.
More on the subject of developing a tolerance and withdrawal may be found at the link at the end of this article.
Characteristics of safe drugs for PTSD:
1. Makes something better for the veteran.
2. Does not lead to a tolerance
3. Does not lead to abuse
4. Cannot be used to commit suicide.
5. Does not require blood tests
6. Does not cut a person off from the world or from themself.
7. Causes few, bearable side-effect
Dr. Shay states that in his opinion, based on his experience with patients, the following would be considered good safe, effective medications for Veterans with PTSD for all the criteria on his list...
1. Serotonin reuptake inhibitors: and #'s 2-7
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil) to name a few
These drugs according to the doctor allow the veteran to have more time to think before spontaneously reacting to a situation or conversation. It does so without sedation or cutting them off from themselves or the world. This type of medication, has been known to kick in as quickly as a week, but more than likely will take many weeks before the full effect and benefit is seen.
As far as being a medication that is safest and not used for suicide he stated he preferred to see the use of Prozac (fluoxetine) the most. Stating it does not seem to be a threat or used as such, and there fore continues to meet more of the desired characteristics of safe medications for PTSD. Although he does note that it is not just the medications themselves but the fact that they were given with a program of therapy and support also going on at the same time. Here he is referring to support from other veterans, family, friends, therapists, and that all working together help to affect this.
He went on to state that Zoloft (sertraline) and Paxil (paroxetine) came on the market after the Prozac (fluoxetine) and seemed to have good result. But made one side note on the subject of Paxil (paroxetine) that it apparently doesn't stay in the system as long, which is a good thing from a safty point of view, but a negative is that there is often reported withdrawal syndrome because it leaves the body so quickly. It only has a 24 hour life span.
2. For criteria #2.. He prefers Buspar (buspirone) for anti-anxiety drugs. Stating that it does take a few weeks to kick in, and takes effect gradually. But it has few side effects and may help with intrusive thoughts and nightmares. It is also nearly useless as a suicide pill.
3. For criteria #3.. The doctor prefered what he calls Beta-Blockers...
propranolol (Inderal)
nadolol (Corgard)
antenolol (Tenormin) etc.
He explained that these medications will help in breaking the mind - body - mind vicious cycle in rage reactions by literally blocking the body effects of adrenalin. And allowing the veteran to have some time to consider what they are thinking of doing. He also said that these medications were orginally started and used to control blood pressure, and need to be used with careful dosages.
4,5,6,7 For criteria #'s.. Dr. Shay still prefers the use of the same medications as listed in #1 over what some others of his field prefer. He states that others prefer dosage amounts of (600 mg/day) of Lithium. But he does not agree with this. He does state that this amount of Lithium is under what would be perscribed to someone with bipolar affective disorder (manic-depressive disorder), he still prefer his same choices listed in # 1. And does not feel lithium meets his criteria for being safe for the veteran to use, unless absolutely necessary. More information may be found on this subject on the link at the end of this article.
Medications/etc to AVOID!
On this point the doctor says up front that this is his opinion, and he has based it upon working with Vietnam Veterans in a Vet Center where he is the staff psychiatrist...and he goes on to state that it may not be a popular opinion with his fellow doctors. But he is very blunt in stating that in his opinion from his experinece, it is important to get Veterans OFF of drugs that are harmful to the Veteran and he doesn't care what doctor perscribed them.
He states Benzodiazepines:
Valium (diazepam)
Xanax (alprazolam)
Ativan (lorazepam) etc.
I am quoting as this is very important.."All the drugs in this class are similar to alcohol. Some people "lose all their inhibitions" on either alcohol or benzos or both. This "dis-inhibition" can affect practically anything that a person thinks he might like to do -- but doesn't do -- when sober.
It has included suicide and murder, but most often involves saying things that cumulatively do great damage to a veteran's life. One of the inhibitions that benzos weakens is the inhibition about saying hurtful things to people we love. Memory loss: All of the benzos weaken the ability to remember what happened a short time ago, including things you yourself did or said. The more potent the benzo, the more it wipes out short - term memory -- and this is probably why Halcion (generic name: triazolam) has been such a bad actor, it's one of the most potent."
"Short-term memory is something that everyone needs to make relationships work, at home, at work, or anywhere. There's the additional stress that vets have when they find themselves forgetting -- veterans have been in real situations where people died because someone forgot. The tension and guilt that this creates in everyday life can be unbearable, and veterans often do not know that their benzodiazepines are responsible for memory lapses.
Mini-withdrawal syndrome between doses: Benzo's differ from one another in how fast they go into the body and how fast they leave. Xanax does not leave the body quite as fast as Halcyon, it is particularly prone to giving mini-withdrawals between doses. It has been Dr. Shay's experience that vets on Xanax have periods of anxiety and irritability during each day that do them great harm, and which in his view are mostly mini-withdrawal reactions between doses.
The other down side found with Xanax used in PTSD during the withdrawal, was reported cases of extreme violence by combat vets treated for long periods with Xanax then taken off of it. The American Lake VA in Washington state have published a paper reporting this very thing.
He also says that caffeine, in the form of coffee, soda's, and headache pills with caffeine, and chocolate can contribute to anxiety and or depression, and if you are unsure to wean yourself off all forms of it over about a week long time frame and then stay off for several weeks to see if it helps.
Actibine, Aphrodyne, Yocon, Yohimex are all drugs that CAUSE flashbacks and panic attacks. These drugs are sometimes used to treat impotence, but should certainly not be used by someone with PTSD. And the last thing which is obvious to avoid is any type of Illegal drugs.
Personal Note from Ranger Mom: It goes without saying that these things are simply one doctors opinion, I am including them on this web site because I have seen too many Veterans over drugged by too may psychiatrist that seem to think that is the solution to everything. Again at the risk of annoying those in the profession... here is the bottom line in my personal opinion where unfortunately many, psychiatrists are concerned. They were first trained and became doctors after many years of hard work. From there they specialized in the field of psychiatry. What they are largely not trained to do is be a therapist. If you want therapy go to a reputable therapist. Someone who's graduate training was devoted to becoming a therapist. A psychiatrist is in all but a few states the only one that can prescribe medications, and the occassional med check visit is needed. In a very small number of states a psychologist can also perscribe medications, but psychologist greatest strength is in psychological testing and evaluating, and a tool that is extremely valuable many times. I personally know of professionals that heartily agree with Dr. Shay's assessment of the above medications, and have relayed many a sad story of just exactly the types of results that Dr. Shay has talked of. The saddest of all has been my personal witnessing of fine good Vets who have been just trashed emotionally and physically, because it was easier to medicate the problem than help the Vet work through it.
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