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Mental Health  (Expert Forum)
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complex ptsd medication suggestions
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

complex ptsd medication suggestions

by Rebecca70, Apr 05, 2004 12:00AM
I've been diagnosed (correctly i believe) with complex ptsd, and am considering medication to help allievate some of my symptoms, predominately: anxiety (panic attacks, social anxiety), depression, and insomnia. I took both zoloft and xanax for a while about 10 years ago, from what i can recall, they helped some, but not amazingly so, and also made me feel somewhat 'zombie-like' and low energy. So, i ended up going off them. I'm currently in psychotherapy, but at this point my symptoms are interferring with my treatment. I have an appointment with my doctor and am trying to educate myself beforehand. I've been reading about some of the anti-depressent and anti-depression medications, and would appreciate an informed opinion. What you think could be a good starting point for me in terms of drug therapy? and/or What sort of options could i expect to be presented with?
Doctor's Answer

by Roger Gould, M.D., Apr 06, 2004 12:00AM
The basic treatment is psychotherapy with an antidepressant like Zoloft, and an occassional use of xanax for an acute episode. There are some experiments going on that use beta blockers, so ask your doctor about that.
Member Comments (12)

by ontherecord, Apr 05, 2004 12:00AM
To: Rebecca70
If you're talking about potential medications, the SSRI's most likely to be the first option presented.  There are newer SSRI's these days (like celexa, and even newer ones than that) that may provide some relief.  You will also be presented with Wellbutrin, which is not an SSRI, due to its safe profile and effectiveness, and also with Effexor (and perhaps other SNRI's).  If there are contraindications to prescribing any of these medications then there is even a chance that you may be presented with a tricyclic antidepressant (such as Amitriptyline).  All these medications have an incidental therapeutic effect on anxiety, but for acute episodes of anxiety, nothing works like a benzodiazepine.  The only issue you'll be presented with if you need relief for anxiety is whether you want a short-acting or long-acting benzo.  The short-acting benzos are tougher to withdraw from.



My prediction: a newer SSRI and perhaps some Klonopin.  Let me know if this prediction holds true.

by Rebecca70, Apr 06, 2004 12:00AM
To: ontherecord
Hi there, thanks a lot for the info, it sounds like you know these medications pretty well.



Anxiety is actually a bigger problem for me than the depression, in that it inhibits my functioning more. What are the drawbacks to the long-acting benzos? Easier to withdraw from sounds good.



Also, i live in denmark, so i'm not sure my chances are very good to be prescribed anything particularly new. and it may well be that my gp will prescribe me something without refering me to a psychiatrist. so, the more i know of the drugs the better my chances at getting something that will work.

by ontherecord, Apr 06, 2004 12:00AM
To: rebecca70
The long-acting benzodiazepine also carry the risk of psychological and physical dependence, much like the short-acting benzodiazepines.  Some antidepressants are actually also approved for Generalized Anxiety (like Effexor, an SNRI, and Lexapro, a newer SSRI), but the type of anxiety relief they provide isn't nearly as potent as the anxiety relief benzos provide.  I would try a benzo for the first 3-4 weeks while taking the antidepressant, because it take a few weeks for the antidepreesant to kick in.  If the anxiety isn't considerably reduced with the antidepressant, you may need a mild dose of a long-acting benzo (like klonopin) while your symptoms persist.  As potent as benzos are, and as good as they make you feel, they do cause some transient cognitive dysfunction; you'll notice your short-term memory slightly impaired, as well as your motor control and speech, depending on the dose.  benzos depress the central nervous system, much like alcohol, and have similar effects.  Therefore, the milder the dose the better.  I wouldn't recommend that you take benzos long-term but unfortunately, the people who benefiit from them therapeutically are exactly the types of people who need them long-term -- that's the rub.  



Ask about Lexapro or Effexor for depression and anxiety.  Ask about a long-acting benzo, and try to manage with as mild a dose as possible.  See how the antidepressant works for the anxiety after a few weeks, and adjust accordingly.  Psychiatric medications and doses are a matter of trial and error.

by Baby123, Apr 06, 2004 12:00AM
To: ontherecord
Hey, I have read several of your comments on this board and you seem to know alot about Anxiety and meds and all.  I have Generalized Anxiety Disorder and after the birth of the last child (12 years ago) I went through post-partum depression and had severe chronic anxiety.  I went on 20 mg. of Prozac, .5 mg of Klonopin and 25 mg. of Tenormin all once a day.  I also have Mitral Valve Prolapse with Dysautonomia so my Dr. left me on the lose doses of the meds for the past 11 years.  January, a year ago, I weaned myself off the Prozac (over a period of about 6 months), had no withdrawals and was feeling fine.  Then in October I started slowly feeling that anxiety creeping up on me again.  It kept getting worse and worse, so I went to a Psych (in December)and he upped my Klonopin to 1 mg. three times a day and put me on Effexor.  I am hoping to wean myself back down to the .5 mg a day of Klonopin in the next few months.  (Already tried once, but symptoms started returning).  I have read nothing but nightmares about withdrawals off Effexor.  I ask my Dr. about putting me back on the Prozac and he said it would be too stimulating for my anxiety.  What I don't understand is why it worked for 11 years?  I felt great. No problems until I came off the med.  What is your opinion on Effexor withdrawals?  He actually said he uses Prozac to wean people off Effexor.  But it is too much of a stimulant for me?  I guess I am confused.  Also, how much do you know about Lexapro?  I've heard it is good for anxiety also.  How does it compare to Effexor with withdrawals and side effects and all?  Thanks.

by ontherecord, Apr 06, 2004 12:00AM
To: Baby123
Excellent questions.  I have read nothing but horror stories as well regarding withdrawal from Effexor.  Effexor is an especially tricky medication, because doses vary from as low as 75mg daily to as high as 375mg a day, or even higher in some cases.  Average dose is between 150mg and 225mg daily.  I surmise that the higher the dose, the higher the potential for withdrawal symptoms.  It is a potent medication, but studies have not indicated that it is any more potent than the SSRI's.  which brings me to the next point.  You may want to try Lexapro, a relatively newer SSRI, which is more "selective" than it's predecessors.  It is indicated for depression and GAD, and works much the same way as the other SSRI's.  Therefore, I would predict that if Prozac worked as well as it did for 11 years, then another SSRI would most probably work as well.  However, if Prozac was effective for all those years, you may just want to begin Prozac again.  You know it works, you know what dosage was right for you, and you know which side effects to expect.  Therefore, beginning prozac once again makes sense to me.  As for the klonopin, I would try to reduce that to your previous dose, for reasons I mentioned above (the lower the dose the better).  



Bottom line: go back to prozac, and if you don't want to do that, then try lexapro, a newer SSRI.  Effexor could very well work too, for both anxiety and depression, but from what I have read, the withdrawal is notably more difficult.

by Rebecca70, Apr 07, 2004 12:00AM
To: ontherecord
Hi again,

Thanks so much for your second set of comments, very helpful and useful stuff. :) I saw my GP today, and ended up with a prescription for something called oxazepam (brand name appears to be Serax in the USA) 15mg dose. I asked about clonazepam (Klonopin) but he wasn't familar with it being used for anxiety. It's apparently classified as an anticonvulsant. Also, I got a referal to see a psychiatrist about getting an anti-depressant, unfortunately first appointment i could get is over two weeks from now. I hope the psychiatrist will know more about klonopin, and will be familar with some of the newer anti-depressants like Lexapro and Effexor. Oh well, I hope this oxazepam will help a little bit at least... less panic attacks would sure be nice, but so far it doesn't seem to have any effect on my constant state of general low-grade anxiety. If you happen to know of any other effective long-acting benzodiazapines besides clonazepam that would be just great. Regardless though, i really have appreciated your input. Reading about all these meds from all these various online sources can be really overwhelming. Thanks again. :)

by Rebecca70, Apr 09, 2004 12:00AM
Just follow-up to anyone with interest...



The Oxazepam (15mg 3xday) wasn't working well enough to control my axiety, and also the effects wore off before i could take another one. So, yesterday I received a new precription for some Lorazepam (2.5mg 3xday) and so far these seem to do the trick. very well actually. I've read that what i got is the highest maximum dosage. I'm curious if a lower dose might also work for me, but i will wait. It's too hard to tell some of the negative side-effects i'm experiecing: sleepiness, decreased motor function... are effects of the drug, or just my body catching up on all the much needed rest it's missed over the past months. Seems reasonable to me. I'm so happy... 6 hours of uninterupped sleep is indecribely beautiful thing! :) There isn't even room for depression when the anxiety is under control. Of course, i'm still learning to manage my anxiety in therapy the natrual way. That should be easier now, when we don't have spend most of the session getting me to relax enough to converse normally.



well, hope this might be helpful to someone. :)