Post-traumatic Stress Disorder (PTSD) (cont.)
IN THIS ARTICLE
What Specialists Treat PTSD?
Most specialists who treat mental health disorders such as depression and anxiety also have experience in treating PTSD, particularly since it is a relatively common disorder. You may find that some professional therapists and counselors (clinical psychologists, clinical social workers, professional counselors) will specialize in trauma-related disorders and have certification with some of the specific therapies, such as EMDR. Medication treatment of PTSD is best managed by psychiatrists who have extensive training in assessing and treating these disorders. Nurse practitioners with certification in psychiatry also have experience with PTSD treatment and work with psychiatrists.
What Are PTSD Medications?
A few medications have been shown to directly reduce the symptoms and distress of PTSD.
The first-line medication treatment for PTSD is the serotonin-specific reuptake inhibitor (SSRI) class of medications. Two SSRIs, sertraline (Zoloft) and paroxetine (Paxil), have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of post-traumatic stress disorder. Most other SSRIs have also been studied and are successfully used in clinical practice for PTSD as well. SSRIs can improve a wide range of PTSD symptoms including re-experiencing, avoidance, hyperarousal, and can improve quality of life. Taking SSRIs for a longer amount of time (36 weeks or more) seems to improve symptoms more. There also seems to be a risk of worsened symptoms if someone stops taking SSRIs after improvement.
Prazosin (Minipres) is an older blood pressure medication that has now been studied extensively for the treatment of PTSD. Prazosin works by blocking some of the effects of the fight or flight nervous system. After initial trials using prazosin to reduce re-experiencing nightmares in combat veterans with PTSD, prazosin has now been shown to be effective for reducing many symptoms of PTSD, regardless of the type of trauma. Prazosin can improve nightmares, sleep time, hyperarousal, and general PTSD symptoms. The U.S. Food and Drug Administration (FDA) has not approved prazosin use for PTSD, but it has been more widely used by psychiatrists in recent years.
For children, there is not as much evidence to support the use of antidepressants, prazosin, or other arousal-dampening medicines (for example, clonidine or propranolol that block some of the effects of adrenaline) as well as for the use of other medications. You should consult a child and adolescent psychiatrist for further information.
In addition to PTSD-specific medications, some people may also require medication to help them with anxiety, depression, addictions, or other psychiatric conditions present along with the PTSD. It is important to have a psychiatrist, or other medical doctor experienced with PTSD, to evaluate which medications would be best and will not interfere with PTSD treatment. For example, the benzodiazepines (including medicines like alprazolam [Xanax], diazepam [Valium], lorazepam [Ativan], and others), a class of medicines used for treating some anxiety, may actually worsen PTSD and make it harder to treat.
Medically Reviewed by a Doctor on 9/11/2017
Michael J. Peterson, MD, PhD
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