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MEDICATIONS FOR SYMPTOMS OF PTSD
JAMES ROSE PA-C
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PTSD Medications
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Not curative …(yet)
I draw the analogy of treating HTN or Diabetes: reduce downstream effects
Require significant education (placebo effect)
Generally, the worse the symptoms, the better the response (and less side effect
problems)
Directly address stigma: “We tend to disparage what we do not understand”
Motivation is 90% of the battle
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WHAT YOU GET WHEN YOU GIVE SILLY STRING TO A
BIOGENETICIST
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Norepinephrine and PTSD
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Acute Response
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Flight response
Fear
Sympathetic activation
Conditioning
Consolidating memory
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Symptom Sequelae
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Hypervigilance
Autonomic arousal
Fear
Exaggerated startle
response
– Flashbacks
– Intrusive memories
Serotonin and PTSD
• Acute Response
• Symptom Sequelae
– Fight response
– Aggression
– Aggressive retaliation
– Violence
– Self defense
– Suicide attempts
– Rage
– Impulsivity
– Attenuation of fear
– Depression
– Anxiety/panic
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Monoamines and
Amino Acid Neurotransmitters
– Monoamines are neurotransmitters
that modulate fast-acting amino acid
neurotransmitters, gamma-aminobutyric acid
(GABA), and glutamate
– GABA and glutamate are the major fast-acting
inhibitory and excitatory neurotransmitters,
respectively, in the CNS.
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GABA and PTSD
• Acute Response
• Symptom Sequelae
– Anxiolytic
– Anxiety
– Neuromodulation
– Reexperiencing (kindling)
– Cognitive function
– Impulsivity
– Hormonal modulation
– Hyperarousal
– Decreased release of CRF
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Sensory Information About Harmful Stimuli
Auditory cortex and auditory thalamus
Lateral nucleus of amygdala
++ Glutamate -- GABA
Central nucleus
of amygdala
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++ 5-HT
DR
Hypothalamus
++CORTISOL
CRF
Pituitary
Adrenal
ACTH
PTSD Meds
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SSRIs
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Citalopram, Fluoxetine, Escitalopram, Sertraline
Only class with FDA approval
Impacts B,C,D,E criteria
Safe
“Broad Spectrum” (Depression, Anxiety)
Side effects: Libido, Weight (either way)
Improves Serotonin activity
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Medications
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SNRIs
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Venlafaxine, Desvenlafaxine, Duloxetine
Affect Serotonin and Norepinepherine receptors
Evidence for efficacy in PTSD similar to SSRIs
Theoretically more “energizing”
May be helpful in chronic pain (Duloxetine)
Monitor blood pressure/ slow titrate up and down
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Medications
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Adrenergic Inhibitors (Blood Pressure Meds)
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(Prazocin, Propranolol, Clonidine)
Reduce autonomic response to memories
Evidence of benefit in traumatic memories
Perhaps will affect memory implantation (“morning after” pill)
Not a “Psych” drug
Side effects: Orthostasis, sexual
May inhibit extinction (if engaged in PE/CPT)
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Medications
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Mood Stabilizers (AEDs)
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Valproic acid, Carbamazepine, Topiramate, Lamotrigine.
Originally marketed for Seizure Disorder (AED)
Enhance GABA (negative feedback) activity
Little direct evidence for efficacy in PTSD
I use for anger/irritability (with SSRI)
Helpful in TBI (emotional lability)
Side effects:Weight, sedation, tremor, metabolic, labs
Potential to affect retention/deployment
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Medications
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Atypical Antipsychotics
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Olanzepine, Quetiapine, Risperidone, Aripiprazole
Act on Serotonin and Dopamine receptors
Indicated for Schizophrenia, Bipolar Disorder, Depression (Aripiprazole only)
Helpful for nightmares/mood (secondary indication)
Significant side effects (metabolic, weight, labs)
Expensive
Potential effect on retention/deployment
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Medications
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“Other” Meds I use…..
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Trazodone (sleep)
Doxepin/Amitriptyline (sleep/depression)
Mirtazepine (sleep/poor appetite/depression)
Ambien (sleep)
Benzodiazepines (sleep/panic “PRN”) (May inhibit extinction)
Bupropion (counter sexual side effects of SSRIs)
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