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Old 01-09-04, 12:59 AM
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are there meds to control PTSD?

I have PTSD among other problems but have no medication to treat it. My flashbacks come without warning and I don't even have to be in a familar place, smells, sounds, or not even familiar music or tv that have same situation of trauma that I have experience with. The only way I can deal with these recuring flashbacks is i yell at them inside my head to go away and leave me alone...sometimes it works sometimes it doesn't. Sometimes I yell at them aloud and people think I am nuts when I say things like NO I DON"T WANT TO ANYMORE GO AWAY!

There must be another way to control flashbacks.
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Old 01-11-04, 08:55 PM
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There are medications (and I think I've taken most of them at some point over the last 10 months).

Firstly, antidepressants

Secondly, antipsychotics

Thirdly, tranquilizers.

The all suck.

I've put on about 20kg and all it's done is delay my dealing with the problem.

I bought this book called "The PTSD workbook" by Mary Beth Williams from Amazon.com and it is the most helpful thing I've found so far. It teaches you step by step how to deal with flashbacks and nightmares and all the other problems that go with PTSD.
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Old 01-11-04, 10:53 PM
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Some of the SSRIs and other meds that are used to help with anxiety probably help with PTSD too.
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Old 01-11-04, 11:35 PM
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While the following was written for soldiers with PTSD, I think the description of meds is worthwhile and valid.

==============

Some good drugs for combat PTSD

Serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), etc.
The main effect of fluoxetine on combat vets with PTSD whom I've worked with is to allow them more time to think before they act, particularly in anger. It does this without sedation or cutting a man off from himself or the world. The duration of anger, once aroused, is also shorter. Greater self-mastery of anger leads to an increase in self-respect and relief from a sense of humiliation. Most men feel humiliated after they go off on people in situations they really would not have, if they had had the freedom to choose. In addition to this, fluoxetine may have a direct anti-depressant effect in combat PTSD. Fluoxetine effects on self-control and rage may take many weeks to kick in, although I've seen it as soon as a week.

Fluoxetine is practically useless as a drug to overdose on, if the goal is suicide. All anti-depressants have been known to give long-time depressed people the energy to kill themselves, and fluoxetine is no different. Many combat veterans go through brief periods of intense despair during the first few months that they are feeling generally better, more alive, and are coming out of their bunkers. Support from other veterans, family, therapists is especially important during those times -- nobody should try to go through it alone, or have to. Someone trying to go through it alone, might try to kill himself during one of these times of despair. Remember that this is no special risk with fluoxetine, but is a risk when anyone recovers from severe depression. Several vets I've treated have had bouts of despair like this, but none has ever tried to kill himself during one, because support and therapy are built into the program I'm a part of. The much publicized claim that Prozac has special powers make a previously non-suicidal person violently suicidal is without good foundation. Fluoxetine does have side effects, which not everyone can stand, and it doesn't work for everyone. A full discussion of side-effects, some of which depend on the dose and others not, would be too long for this summary.

Fluoxetine is the first drug of its type to be released for use. Other drugs in the same family have now come along, sertraline (Zoloft) and paroxetine (Paxil). They have been tried by many combat vets around the country, and from what I hear they are not a lot different than fluoxetine as far as main and side-effects. In the relatively limited number of men I have treated with paroxetine and sertraline, this has been what I have heard from them. Paroxetine has a 24 hour half-life and no active metabolites [what the body turns the parent drug into], so if the actions of the drug are otherwise identical to fluoxetine, it will be a superior drug from a safety point of view, because it doesn't hang around in the body so long. But on the down side, paroxetine may be expected to (and is reported to) have a withdrawal syndrome because it leaves the body so fast.


Buspirone (Buspar)
This anti-anxiety drug works differently from the benzodiazepines (like Valium). Like anti-depressants it takes a few weeks to kick in. It takes effect gradually, like the tide coming in. It usually has few side-effects and may help some people with intrusive thoughts and nightmares. Buspirone has no street value and is almost useless as a suicide pill. I am not aware of other drugs in this family coming along, but I hope there will be. I have recently read the report of a colleague who works with combat veterans that the best results with buspirone come at doses above 60mg/day. I do not yet have enough personal experience with patients who have tried this, to confirm or deny this report.


Beta-blockers: propranolol (Inderal), nadolol (Corgard), atenolol (Tenormin), etc.
This family of drugs breaks the mind-body-mind vicious cycle in rage reactions, by blocking the body effects of adrenalin. For example, if someone at work says something offensive about Vietnam vets, the words start the mind working into rage. The rage starts in the mind -- but within a second the body responds with adrenalin, which makes the gut burn, the heart pound, the muscles tense. These body changes send loud messages back up to the mind. For some veterans, the roar of the body drowns out all thought and shuts out everything else coming in. When adrenalin is roaring, it's impossible for most people to think clearly and to take in non-combat possibilities in the situation. This is the mind-body-mind vicious cycle that beta-blockers break up. By blocking the adrenalin effect on the body they prevent the roar of the body from drowning out all thought and choice about what you really want. "Is it really in my interests to rip this guy's lungs out? Is it really what I want to do?" When adrenalin is roaring these questions sometimes cannot be heard.

Some vets feel that these medications weaken them, because they associate being pumped up with adrenalin with their personal strength. When someone is over-medicated on these drugs (which started life as blood pressure meds) he is weaker because his blood pressure is too unstable, but this is usually not a problem with a correct dose.Tolerance does not develop to the anti-adrenalin effects of these drugs. Massive overdoses of a beta-blocker can be fatal, by dropping the blood pressure and slowing the heart to the point that the brain is not getting enough blood flow.


Low-dose lithium
Some respected practitioners of PTSD pharmacotherapy speak highly of lithium to help veterans maintain their self-control when they are angry. This means doses of about 600mg/day, far less than is usually need to treat bipolar affective disorder (manic-depressive disorder), and does not imply that the doctor recommending this thinks that the veteran is manic-depressive.

I agree that this can help some veterans, but I have found fluoxetine to be more reliable. It is also safer, in that lithium is readily fatal in a large overdose. For a veteran who cannot tolerate fluoxetine and whose life has been blighted by explosive violence, low-dose lithium may be a good thing to try. [no blood tests because of low dose]


Other drugs for special circumstances

Trazodone (Desyrel) for sleep
Trazodone is a non-toxic anti-depressant that has a useful side-effect: It causes drowsiness, and people don't get tolerant to this effect. Because fluoxetine slows the rate that the liver breaks down trazodone, much lower doses are needed for sleep by patients on fluoxetine than people who are not on fluoxetine.


Quinine for nocturnal myoclonus
This is the "sleep jerks." If quinine works, the veteran himself may not notice much but his wife has much better sleep.


Low-dose antipsychotics for violent urges: thioridazine (Mellaril), mesoridazine (Serentil), etc.
The key here is brief treatment on an as-needed basis, controlled by the veteran himself. [for a limited time, when hospitalization is not possible] The doses needed have been low, and I prefer the sedating anti-psychotics like thioridizine and mesoridizine, which appear to carry the least risk of dangerous (neuroleptic malignant syndrome) or possibly irreversible (tardive dyskinesia) complications. An unexpected additional use for these drugs also involves brief, low-dose treatment: to help someone who wants to get off marijuana get through the withdrawal syndrome.


Future drugs
Many combat veterans with PTSD feel dead inside. It is possible that this psychic numbing comes from the brain making its own opium-like substances, and that opiate blockers can give people back their feelings. It is not yet clear whether this works.

I hope the future will bring a drug like clonidine (trade name: Catapres) that people do not develop a tolerance to. In my experience, about one out of five combat veterans with PTSD experience major improvement of almost all of their PTSD symptoms on clonidine -- but the heartbreak has been that they grew tolerant to it in about a week. Any future drug in this family that does not induce tolerance to this effect will relieve much suffering. A new drug in this family, guanfacine (tradename, Tenex) has recently appeared, but I have no experience with it and have not heard any reports of usefulness to combat veterans with PTSD.

The most helpful drugs are likely to be ones that don't yet exist.


Things to avoid
One of the useful things I do for veterans I see is help them identify and get off of drugs that they use (whether prescribed by doctors of not) that are harming them. Some of what I say here is likely to be controversial.


Benzodiazepines: diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), etc.
Disinhibition: All the drugs in this class are similar to alcohol. Some people who "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. A lot of family stress among veterans comes from things said to wives and children the veteran wishes he hadn't said, the moment it was out of his mouth. 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 -- this is probably why Halcion (generic name: triazolam) has been such a bad actor, it's one of the most potent. Here's a little scene that everyone has experienced one way or another:

"I'm going out for cigarettes -- want anything?""Quart of orange juice and a box of Pampers.""OK" Half hour later you're back -- with your cigarettes! No one is 100% on things like this, but people on benzos are sometimes close to zero.

Short-term memory is something that everyone needs to make relationships work, at home, at work, or anywhere. There's the additional stress that combat vets have when they find themselves forgetting -- they 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.

Confusion of pleasant side-effects with main effect: The pleasant, couple-of-drinks, or drowsy feeling that you get when you first take a benzo (especially the ones that are rapidly absorbed into the blood) is a side-effect that most (not all) people get tolerant to. Because it comes on at the same time as the anti-anxiety effect, it is natural for patients to think that this pleasant feeling is the anti-anxiety effect. One of the strengths of the benzos is that people do not get tolerant to the therapeutic anti-anxiety effect. A very common problem is that people feel the drug is quitting on them when they become tolerant to the pleasant side-effect, and become very afraid that their anxiety symptoms will return. Often out of fear of fear, they double up on their meds and pressure their doctors to increase their dose. This natural confusion of a gradually weakening, pleasant side-effect with the main effect is responsible for some addictive properties of the benzos.

Mini-withdrawal syndrome between doses: Benzos differ from each other mainly in their pharmacokinetics, that is, how fast they go into the body and how fast they leave. Mini-withdrawal reactions are particularly likely to happen with the benzos that leave the body quickly, such as Halcyon (generic name: triazolam). This is why people who take this drug for sleep often wake up in the middle of the night because they are in the withdrawal phase. Though Xanax does not leave the body quite as fast as Halcyon, it is particularly prone to giving mini-withdrawals between doses. My observation has been that many combat vets on Xanax have periods of anxiety and irritability during each day that do them great harm, and which, in my view are mostly mini-withdrawal reactions between doses.

Possible dangerous peculiarities of Xanax in PTSD during withdrawal: The staff of the in-patient PTSD unit at the American Lake VA in Washington State have published a paper reporting extreme violence by combat vets treated for long periods with Xanax and then taken off of it. This was apparently more frequent and more severe than what they found taking their patients off of other benzos, such as Valium. Several Vietnam combat veteran peer counselors whom I respect very highly, feel that Xanax has done a lot of harm. Xanax has some unique properties among its cousins in the benzodiazepine family. In lab tests Xanax acts the opposite at low blood levels of how it acts in the larger amounts actually used in medical practice. When you think about it, everybody passes through a low blood level twice when they take a pill -- once when the pill is just being absorbed in the body and once when the body is almost done getting rid of it (unless, of course, the person takes the same pill again, before the first one is completely gone). Whether this is what causes the problems with Xanax is not clear right now.


Caffeine
The pharmacology of caffeine is horribly complicated: it's not just one drug, it's really three, each of which can have a different effect on different people. The way it's three drugs is that it's the original caffeine, then the body converts it into theobromin, which the body then converts into theophyllin. The peak effects of these three successive drugs are roughly two hours for caffeine, four hours for theobromin and six hours for theophyllin. The good effects that any of these three drugs can have is feeling more awake, energetic, and optimistic. The bad psychological effects that any of these three drugs can have are anxiety and depression. A given person does not necessarily react to all three the same way. (I'm not talking here about the well-known effects of caffeine on sleep -- this is another important topic in itself. What many people are unaware of is that at very high doses -- like 15+ cups of coffee a day -- caffeine can reverse on you and it can be impossible to stay awake, unless the caffeine is stopped.)

Someone who reacts badly to caffeine itself has usually found that out long ago, because the anxiety and/or depression hits them soon after the big mug of coffee. These people know it's not for them. But there are literally millions of people who feel good after caffeine itself but have bad reactions to either theobromin or theophyllin (four or six hours after that big mug of coffee) and just think it's their life that's out of whack, not their brain chemistry THERE IS NO WAY TO TELL WHETHER CAFFEINE AND ITS METABOLITES ARE RESPONSIBLE FOR YOUR ANXIETY AND/OR DEPRESSION UNLESS YOU TAKE YOURSELF OFF IT COMPLETELY FOR SEVERAL WEEKS. This means coffee, tea, Coke, Pepsi, Mountain Dew, Jolt, headache pills with caffeine. Some people are so sensitive to it that even the small amount of caffeine in decaffeinated coffee and in chocolate causes psychiatric symptoms. If you decide to take yourself off caffeine to see what your life is like, don't go cold turkey. Taper yourself off over a week or so, or you are likely to get severe withdrawal headaches.


Yohimbine
Yohimbine (brand names: Actibine, Aphrodyne, Yocon, Yohimex) is absolutely contraindicated in combat PTSD. It causes flashbacks and panic attacks. This drug is sometimes used to treat impotence.


Any illegal drug
The problems and appeals of specific illegal drugs in combat PTSD is a very big subject that can't be covered here, but all illegal drugs cause the following problems for combat vets with PTSD.Expense is the first problem -- I know there are Vietnam vets who have been very successful financially, but the men I know who have severe, chronic PTSD have a heroic struggle to make ends meet. I know it's stating the obvious, but the first problems of illegal drugs is the expense.

The second problem is much more subtle -- Getting illegal drugs involves you in relationships with and obligations to people you normally wouldn't let within a mile. Most of the combat vets I know have a very sharp eye for quality in human beings, and feel constantly tainted by the people they get involved with to support their habits. The third problem is that situations of real danger and the presence of weapons gets in the way of healing from PTSD. In this country and time it's not possible to sustain a drug habit over a period of years without running into situations that rekindle PTSD because of their real combat elements.

The fourth problem is the worst -- using illegal drugs often puts veterans in situations where they bring down other vets. Calling for rescue is a very common way of bringing down other vets, even if the rescue is "successful." Users need to be rescued from the medical complications of their habits, from the pressure of debts to dealers, and so on. Vets who have been on rescue missions are put back into combat-mode and are wired for weeks after a rescue. Sometimes users bring down other vets by asking them for dangerous favors (e.g., "hold this for me till I come for it" where "this" is a parcel of drugs or drug-related weapons or money). And finally -- this is really obvious but it needs to be said -- if a fellow vet is trying to stay clean and you're using, this amounts to a standing invitation to break out.
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Old 01-12-04, 12:55 AM
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Wow Big that's a lot of reading...lol! but thank you I will bring this up with my doctor..he is trying to focus on controling my Bipolar and ADHD...and work on PTSD..easy for him to say he doesn't have nightmares(sleeping or awake) of boyfriends trying to kill him or consant flashes of memory of his father dying in the hospital...I have and more frequent lately...I wonder is the Lamictal is causing it...if Adderal could make my bipolar worse couldn't other drugs for bipolar affect Ptsd?
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Old 01-12-04, 12:57 AM
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Thanks Turdorose and Tara and Big I knew there had to be some other kind of help out there other than just yelling the flashbacks away.
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Old 01-12-04, 01:15 AM
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Stimulants are the only substance that I know of that makes PTSD worse (which sucks if you need to be on them for ADD). I think your doc is doing things back to front. He needs to help you deal with the flashbacks and nightmares instead of only dealing with the other things, coz the PTSD could be setting off the bipolar and I know (from experience) that it makes ADD worse. I can't see how he can get a clear clinical picture when he's ignoring such an important issue. To compare it to a physical injury, it's like trying to stop the bleeding before removing the weapon.

Sometimes I wonder if these docs really understand PTSD coz like you, I've been getting stuffed around too. If there's one thing I've learned is that to get anywhere, you can only really rely on yourself and your own resources coz doctors don't give a sh*t.
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Old 01-12-04, 01:21 AM
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Thanks babe I will definetly bring this up with him..he is a good doc...but he maybe overlooking it unintentionally.
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Old 01-13-04, 08:09 AM
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There's a pretty good chart at http://www.adaa.org/AnxietyDisorderInfor/chart.htm
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Old 03-19-05, 09:43 AM
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I am a little at loss with my recent diagnosis of PTSD I don't have flashbacks, or nightmares associated any more with that part of my life. Though I did at one time in the past it is not now.

Though I can understand how you feel about things coming to mind when you don't want them to, I have that all the time when I start thinking negatively... what I do is not Yell, but instead I say "I DON'T KNOW" over and over to myself saying it out loud if it is not going away at first when I try. I just started that in recent months with the stress here. But it does work for me, and it don't look so strange if someone asks you what you said. I just tell them I am talking to myself and go right along.

Currently I am on Zoloft and it stated for treatment of PTSD.
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Old 03-23-05, 01:50 AM
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Quote:
Originally Posted by Andrew
While the following was written for soldiers with PTSD, I think the description of meds is worthwhile and valid.

==============

Some good drugs for combat PTSD
...


Other drugs for special circumstances

Trazodone (Desyrel) for sleep
Trazodone is a non-toxic anti-depressant that has a useful side-effect: It causes drowsiness, and people don't get tolerant to this effect. Because fluoxetine slows the rate that the liver breaks down trazodone, much lower doses are needed for sleep by patients on fluoxetine than people who are not on fluoxetine...
I could be mistaken, but I thought this was the one that my doc warned me could cause nightmares. Or maybe it was the one that wasn't supposed to but did, but just after the first time? I'm not sure. But having managed to conquer nightmares (waking up with anxiety and/or panic attacks doesn't count), having even one was, well, like a flashback. I actually screamed out loud--something I don't think I ever did in the past.
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Old 04-07-06, 11:36 PM
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Anyone thought about MDMA? Haven't seen it mentioned specifically.

I don't know how hard it is to get it over there in the US. Good luck.

I've done MDMA in guided visualization psychotherapy to pacify with some trauma.

I think it has done a good job. Lowered inhibitions, more empathy, loving oneself and everything. I spoke from the heart. Felt renewed, upgraded in my emotions. It persisted since then.

Now the psychologist wants me to go do it again without MDMA, but I've been 30m late for a lot of appointments so there hasn't been decent conditions to repeat, doh.

Anyway, my 23 cents are, if you can, give it a try.

It wouldn't ever need to be taken regularly, which isn't the fact for all the other meds.

I wonder if you PTSD's have considered it? I have no PTSD but am in solidarity

Everything great to you all.

Cheers,

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Old 04-20-06, 07:51 PM
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Quote:
Originally Posted by Draga
Sometimes I yell at them aloud and people think I am nuts when I say things like NO I DON"T WANT TO ANYMORE GO AWAY!
Wow I thought I was the only one that did this. Although I don't leave the house much so no one hears me yell but my dogs. Most times I yell when I'm hiding. I like hiding under my covers. I curl up as small as possible I guess thinking if nobody can see me they will go away. Which is stupid I know because no one is really there.

A lot of times my flashbacks start with hearing things before I see or feel anything. I yell at them to stop talking to me and sometimes it works. I usually stay hidden for a little bit just to make sure. I also yell leave me alone and dig my nails into my arms or legs it helps me know it's not real. It helps with nightmares too because if I dig my nails in and feel no pain that means it's a nightmare and I can wake myself up.

Obviously these aren't great solutions but I figured I'd share since what you said sounded so familiar.
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Old 05-13-06, 07:13 PM
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It has been a while since I posted here and I still use the "I don't know" method, I also have some side affect from medication that makes me rock, tap my feet, shake my leg also moving my toung all of the time back and forth across my gums. Out of them the rocking helps the best when I am feeling stressed.
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Old 05-13-06, 08:13 PM
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I do something akin to hiding under the covers like Mafiakiddo.
The thought of sleeping can be terrifying when you're afraid the nightmares are waiting for you.
I have this thing I do in my mind -
I have the images in my mind, all mapped out and every inch is detailed.
I go down very confusing hallways filled with doors. Only I know which doors to go through. I reach a huge underground cave where I must hop across rocks that are coming up from the ground, which is way, way down (would be deadly to fall).
Only I know which rocks to step on. Stepping on the wrong one will cause it to crumble under your feet.
I then slip through cracks in the walls, but only I know which ones. If anyone else is lucky enough to notice the cracks, picking the wrong ones would get them lost forever in the cave's maze.
Then I go down a long, dark tunnel. At the end is a 5 foot thick steel door. Only I have the key.
I unlock the door. Go in. Shut it. Lock it. I'm in a tiny circular room carved out of the rock of a mountain. No windows. No one ever knows I go down there.
The only furniture is one chair.

No one can find me.

Going to that place in my mind is the only time I feel safe.
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