I am treating a mid 50's male patient with non-combat related PTSD, specifically related to a horrific divorce 6 years ago that came close to destroying his sense of self. He functioned quite well prior to this, but also is DX with ADHD for which he has been prescribed generic Adderall for over 15yrs which has been quite useful. His only medical difficulty is Type 2 diabetes, dx about 10 years ago which is extremely well controlled with metformin 1000mg BID. He is currently also prescibed Wellbutrin 150SA once a day, as well as alprazolam 1mg QID. His depressive SX's at one point were of such severity he was prescribed Lamictal 100mg. He is no longer taking Lamictal, but remains moderately dysphoric, markedly anhedonic, has bouts of moderate agorophobia, occasionally intense nightmares as well as continuing moderate to severe anxiety. He is able to function well at his job, but avoids almost all social situations and remains anhedonic. The most significant issues at this time are his level of anxiety and his anhedonia, which are quite distresing. Individual psychotherapy has been ongoing. I am wondering if any medications beyond the traditional medications for PTSD have been shown to be helpful targeting specifically this type of ongoing anxiety and anhedonia.
Hi- Nopsycho89- No, from the research I did it sounds as if your patient is going to have to do some deeper therapy.Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person's views and beliefs about their life, not on personality traits. Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families. Replacing ways of living that do not work well, with ways of living that work, and giving people more control over their lives are common goals of behavior and cognitive behavior therapy. Think of it as physical therapy of the mind. Good luck and happy 2013! RC4
In my experience, he is on a low dose of Wellbutrin and a relatively high dose of xanax. There are many, many antidepressants that work well for anxiety that go along with the Wellbutrin. I have found that many years of therapy and the right combo of meds to be remarkable for me. When you speak of the traditional medications to which are you referring?
actually there are a lot of medications and research being done for the treatment of PTSD. There's a book called "The Clinicians Guide to Medications for PTSD" by Matt Jeffrey's, MD. I just copied this first part to give you an idea. I hope this offers some hope and I wish you the best!!!
Posttraumatic Stress Disorder (PTSD) has biological, psychological, and social components. Medications can be used in treatment to address the biological basis for PTSD symptoms and co-morbid Axis I diagnoses. Medications may benefit psychological and social symptoms as well. While studies suggest that cognitive behavioral therapies such as prolonged exposure (PE) and cognitive processing therapy (CPT) have greater effects in improving PTSD symptoms than medications, some people may prefer medications or may benefit from receiving a medication in addition to psychotherapy.
Currently, the evidence base is strongest for the selective serotonin reuptake inhibitors (SSRIs). The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil) (1, 2). All other medication uses are off label, though there are differing levels of evidence supporting their use. In addition to sertraline and paroxetine, there is strong evidence for the SSRI fluoxetine (Prozac) and for the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) which are considered first-line treatments in the VA/DoD Clinical Practice Guideline for PTSD. There are a number of biological changes which have been associated with PTSD, and medications can be used to modify the resultant PTSD symptoms. Veterans whose PTSD symptoms have been present for many years pose a special challenge. Studies indicate they are more refractory to the beneficial effects of medications for PTSD symptoms (3).
What core PTSD symptoms are we trying to treat?
The three main PTSD symptom clusters are listed below:
Re-experiencing. Examples include nightmares, unwanted thoughts of the traumatic events, and flashbacks.
Avoidance. Examples include avoiding triggers for traumatic memories including places, conversations, or other reminders. The avoidance may generalize to other previously enjoyable activities.
Hyperarousal. Examples include sleep problems, concentration problems, irritability, increased startle response, and hypervigilance.
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