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Insight into PTSD Medication

written by: Sean G • edited by: Daniel P. McGoldrick • updated: 11/6/2010

Post-traumatic Stress Disorder (PTSD) is a pervasive anxiety disorder that has been understood well, but it has not yet been completely cured. Current options for treatment usually include extensive therapy in conjunction with medication that is tailored to treat the most severe presenting symptoms.

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    PTSD Symptoms and Treatment

    PTSD typically involves the vivid re-experiencing of a traumatic event, precipitating a heightened arousal and vigilance in situations where no actual danger is present. This is mainly brought about by increased activity of the sympathetic nervous system, related to the 'fight-or-flight' phenomenon, leading to increased heart rate, blood pressure, difficulty sleeping, recurrent nightmares, among other unfavorable symptoms. Depression, generalized anxiety, emotional numbness, and avoidance of activity also present in many PTSD patients. Different PTSD medications are used to respectively treat the more severely presenting symptoms in patients.

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    SSRIs

    Selective serotonin reuptake inhibitors (SSRIs), commonly known as anti-depressants, are a class of medications that aim to improve overall mood by increasing the amount of serotonin (a neurotransmitter involved with emotional regulation) in the brain. Specifically, the SSRI is a molecule that blocks the reuptake of serotonin at the gaps between brain neurons.

    Normally, after a neuron fires and releases serotonin, it clears the amount of serotonin at the gap so that it doesn't continue to have an effect on other neurons. By blocking this clean-up action, the total amount of effective serotonin is increased, contributing to increased mood regulation. People with major depression, which is often co-morbid with PTSD, are purported to have a lower baseline level of serotonin. SSRIs have also been used to treat anxiety disorders due to the increased mood regulation.

    SSRIs typically take up to 3-4 weeks to have full efficacy, as they are thought to re-wire the brain's normal firing patterns over that period of time. Individuals respond variably to different medications, so although the basic function of each SSRI is the same, they may differ slightly in their detailed mechanistic action. This class of medications is often used as a first-line treatment for sufferers of PTSD.

    Common SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Luvox (fluvoxamine).

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    Benzodiazepines

    Benzodiazepines, commonly known as benzos, are a class of medications that aim to decrease overall anxiety by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA is an inhibitory molecule that normally works in the brain to decrease overall neuron firing, or brain activity.

    By enhancing GABA's effect, benzodiazepines induce anxiolytic (anxiety-relieving) and sedative (sleep-inducing) effects on a person. PTSD patients are afforded short-term relief by the reduction of anxiety, hyperarousal, and sleep disturbance.

    Common benzodiazepines, used in PTSD treatment, include Klonopin (clonazepam), Xanax (alprazolam), and Valium (diazepam).

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    Alpha-adrenergic Agonists

    Alpha-adrenergic receptors, which are part of stress response in the nervous system, activate to reduce sympathetic characteristics such as hyperarousal, increased heart rate, hypertension, and other somatic symptoms. PTSD medication includes alpha-adrenergic agonists, which by definition activate alpha-adrenergic receptors to decrease sympathetic output.

    Catapres (clonidine) and Minipress (prazosin) are the most widely used medications for these specific symptoms of PTSD.

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    Beta Blockers

    Beta blockers (β-blockers), such as Inderal (propranolol), are beta-adrenergic antagonists, meaning they block the activity of beta-adrenergic receptors. These receptors normally activate in the presence of stress hormones, such as epinephrine, to increase arousal and cardiac activity. Blocking this activity, propranolol is a useful medication to reduce hyperarousal symptoms and can reduce sleep disturbances.

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    Other Medications

    Risperdal (risperidone), an atypical antipsychotic, functions by antagonizing several classes of serotonin and dopamine (related to excitability) receptors. The exact mechanism of action is unknown, but it helps to decrease PTSD symptoms of dissociation, mood issues, and aggression.

    Ambien (zolpidem), has been widely used to treat sleep disturbances, which are prevalent in those with PTSD. It functions at the same brain areas as benzodiazepines, but it is not classified as such due to its distinct chemical nature.

    There are also many other medications that are used off-label to treat various symptoms; it is important to note that there is no "catch-all" medication for PTSD, as the disorder is defined by a cluster of symptoms. It is recommended for one to speak with a psychiatrist to discuss the best course of action for therapy and an individually-tailored PTSD medication regimen.

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    References

    Shen, Howard (2008). Illustrated Pharmacology Memory Cards: PharMnemonics. Minireview. pp. 12.

    Maxmen, J. S.; Ward, N. G. (2002). Psychotropic drugs: fast facts (third ed.). New York: W. W. Norton. p. 349

    Berger, W.; Mendlowicz, MV.; Marques-Portella, C.; Kinrys, G.; Fontenelle, LF.; Marmar, CR.; Figueira, I. (Mar 2009). "Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review.". Prog Neuropsychopharmacol Biol Psychiatry 33 (2): 169–80.