Talk:Post-traumatic stress disorder/revision-work-area

Symptom prevention: potentially useful medication classes
Alpha-adrenergic agonists. Anecdotal report of success in using Clonidine ("Catapress") to reduce traumatic stress symptoms suggests that it may have benefit in preventing PTSD.

Beta blockers. Propranolol ("Inderal"), like clonidine, may be useful if there are significant symptoms of "over-arousal". These may inhibit the formation of traumatic memories by blocking adrenaline's effects on the amygdala. Glucocorticoids. There is some evidence suggesting that administering glucocorticoids immediately after a traumatic experience may help prevent PTSD. Several studies have shown that individuals who receive high doses of hydrocortisone for treatment of septic shock, or following surgery, have a lower incidence and fewer symptoms of PTSD.

Opiates. In a retrospective analysis of combat injury field data for US troups in Iraq, it was found that those who received morphine in the early stages of their treatment had a significantly lower rate of subsequent PTSD, when compared with those who did not receive morphine at that time.

Symptom management: potentially useful medication classes
A variety of medications has shown adjunctive benefit in reducing PTSD symptoms, but "there is no clear drug treatment for PTSD". Positive symptoms (re-experiencing, hypervigilance, increased arousal) generally respond better to medication than negative symptoms (avoidance, withdrawal), and it is recommended that any drug trial last for at least 6-8 weeks. Among the anti-depressants described below, bupropion and venlafaxine have the lowest patient drop-out rates. Sertraline, fluoxetine, and nefazodone have a modestly higher drop-out rate (~15%), and the heterocyclics and paroxetine have the highest rates (~20%+). Where drop-out is caused or feared because of medication side-effects, it should be remembered that most patients do not experience such side-effects.

Alpha-adrenergic agonists. Prazosin ("Minipress"), in a small study of combat veterans, has shown substantial benefit in relieving or reducing nightmares. Clonidine ("Catapress") can be helpful with startle, hyperarousal, and general autonomic hyperexcitability.

Anti-convulsants, mood stabilizers, anti-aggression agents. Carbamazepine ("Tegretol") has likely benefit in reducing arousal symptoms involving noxious affect, as well as mood or aggression. Topiramate ("Topamax") has been effective in achieving major reductions in flashbacks and nightmares, and no reduction of effect was seen over time. Zolpidem ("Ambien") has also proven useful in treating sleep disturbances.

Lamotrigene ("Lamictil") may be useful in reducing reexperiencing symptoms, as well as avoidance and emotional numbing. Valproic acid ("Depakene") and has shown reduction of symptoms of irritability, aggression, and impulsiveness, and in reducing flashbacks. Similarly, lithium carbonate has worked to control mood and aggressions (but not anxiety) symptoms. Buspirone ("BuSpar") has an effect similar to that of lithium, with the additional benefit of working to reduce hyperarousal symptoms.

Antipsychotics. Risperidone can be used to help with dissociation, mood issues, and aggression.

Atypical anti-depressants. Nefazodone ("Serzone") can be effective with sleep disturbance symptoms, and with secondary depression, anxiety, and sexual dysfunction symptoms. Trazodone ("Desyrel") can also reduce or eliminate problems with disturbed sleep, and with anger and anxiety.

Beta blockers. Propranolol ("Inderal") has demonstrated possibilities in reducing hyperarousal symptoms, including sleep disturbances.

Benzodiazepines. These can be used with caution for short-term anxiety relief, hyperarousal, and sleep disturbance. While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD, or of any effectiveness in the treatment of post traumatic stress disorder. Glucocorticoids. Additionally, post-stress high dose corticosterone administration was recently found to reduce 'PTSD-like' behaviors in a rat model of PTSD. In this study, corticosterone impaired memory performance, suggesting that it may reduce risk for PTSD by interfering with consolidation of traumatic memories. The neurodegenerative effects of the glucocorticoids, however, may prove this treatment counterproductive. Heterocyclic / Tricyclic anti-depressants anti-depressants. Amitriptyline ("Elavil") has shown benefit for positve distress symptoms, and for avoidance, and Imipramine ("Tofranil") has shown benefit for intrusive symptoms. Monoamine-oxidase inhibitors (MAOs). Phenelzine {"Nardil") has for some time been observed to be effective with hyperarousal and depression, and is especially effective with nightmares. SSRIs (selective serotonin reuptake inhibitors). SSRIs are considered to be a first-line drug treatment. SSRIs for which there are data to support use include: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. Miscellaneous other medications. Clinical trials evaluating methylenedioxymethamphetamine (MDMA, "Ecstasy") in conjunction with psychotherapy are being conducted in Switzerland and Israel.

Medications by symptom group affected
Medications can affect one or more of the symptoms, in one or more of the three major symptom classes involved in diagnosing PTSD, which can be summarized in the following table :

Some medications can also help with symptoms which may occur secondary to PTSD.

Medication and Self-medication issues and risks with PTSD
Alcohol and drug abuse commonly co-occurs with PTSD. Recovery from posttraumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened, by medication or substance overuse, abuse, or dependence. Resolving these problems can bring about a marked improvement in an individual's mental health status and anxiety levels. Benzodiazepines are risky in several ways. They can be especially addictive when PTSD is present, and this is especially true with the fast-acting ones. Dis-inhibition upon initiation of treatment is another risk with this medication class. Finally, termination of the drug can be especially difficult. Recovery from benzodiazepine abuse or dependence tends to take a lot longer than recovery from alcohol abuse or dependence, but people can regain their previous good health. PTSD symptoms may temporarily worsen however, during alcohol withdrawal or benzodiazepine withdrawal. Yohimbine (not considered specifically appropriate for PTSD) increases arousal by increasing release of endogenous norepinephrine, and can worsen PTSD symptoms.