complex ptsd medication suggestions

[Rebecca70]

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?

[Roger Gould, M.D.]

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.

[ontherecord]

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.

[Rebecca70]

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.

[ontherecord]

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.

[Baby123]

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.

[ontherecord]

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.

[Rebecca70]

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. :)

[Rebecca70]

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. :)

[walkinghorse]

I am on Lexapro and a low dose of Xanax. It has worked wonders!
I have no side effects from the Lexapro and at first the Xanax made me sleepy. I started out with half a pill and now take the whole pill (05mg) If I don't need to take it I have zero side effects. Everyone is different but it made a BIG difference in my life. Good luck.  KK

[down§out]

I AM A VETERAN OF OPERATION IRAQI FREEDOM. I WAS DIAGNOSED BY THE ARMY AS HAVING PTSD. I HAVE HAD OUT PATIENT AND IN PATIENT THERAPY. I WILL BE FINE FOR ABOUT 3 WEEKS THEN I FEEL THE SAME ALL OVER AGAIN. I AM CURRENTLY TAKING 150MG EFFEXOR AND 200MG ZOLOFT. I ALSO TAKE 400MG OF SEROQUEL TO SLEEP. I HAVE SEROQUEL IN 25MG TABLETS FOR ANXIETY. SOMETIMES I CAN SLEEP AND SOMETIMES I CANN'T. THE ONLY THING THEY SEEM TO DO FOR ME IS KEEP UPING THE DOSES. I NEED SO REAL HELP. I HAVE INSOMNIA, FLASHBACKS, NIGHTMARES, NIGHT SWEATS, NIGHT JERKS. I CAN SEE AND SMELL THE COMBAT SOME TIMES. I HAVE IN MY SLEEP HIT MY WIFE(NIGHT JERKS). I HAVE COME TO MY WITTS END DOES ANYBODY HAVE A SUGGESTION FOR ME. THANK YOU

[combatptsd]

Thank you Soldier
                                                  
Have you stopped to thank a veteran today?
For the price of freedom they had to pay?
Did you gaze into those distant eyes?
Did you see the ghosts he can't deny?
Did you think a soldier's heart was made of steel?
Because he was trained to kill, he couldn't feel?
Did you see the guilt written on his face,
For the loss of life he can't replace?
Did you know he mourns the lives he couldn't save,
And walks with comrades in their grave?
Did you remember the boy with innocence lost?
Do you really know war's ultimate cost?
Have you felt the blast of artillery fire?
Do you have the courage it would require?
Have you stood in trenches consumed with fear?
Felt the enemies breath so very near?
Have you walked with God on a battleground?
Seen your brothers dead or dying all around?
Have you stopped to thank a vet today,
Or did you just turn and walk away?
From the pain he'll carry for the rest of his life,
Did you consider his family, his children, his wife?
That watch him suffer in silence each and every day,
As he's haunted by memories that don't go away?
Did you care that the soldier is still pulling guard?
That his heart, mind, and soul will forever be scarred?
Do you know how he suffers from ptsd?
Or that our precious freedom is never free?
Did you care that he still hears the blood curdling screams?
Or that he returns to the war each night in his dreams?
Have you felt the sorrow of a combat vet?
Or would you rather just forget?
That war has pierced his hardened heart,
And torn this soldier all apart?
Would you rather our heroes just fade away?
Or will you stop to thank a vet today?

By Chris Woolnough   10/29/03

Please check out our Veterans alert, just say no!
The seroquil can cause permanent neurological damage, not to mention make men produce breast milk, and reduces sperm counts, that never recover! hope you don't mind suffering from diabetes from now on too? Other serious side effects, however, include Neuroleptic Malignant Syndrome (NMS), Tardive Dyskinesia, stroke or stroke-like events, and even death.  (NMS is a potentially fatal syndrome involving muscle rigidity, and irregular blood pressure and pulse).  
Tardive Dyskinesia is a central nervous system disorder, which results in involuntary movement of the limbs and twitching of the face and tongue.)
http://www.coreynahman.com/atypical-antipsychotic-lawsuits.html
  I hate the VA, and how they drug NORMAL. PTSD is not a mental disorder! It's a NORMAL reaction to stress/trauma. Thank you brave soldier. Please, don't let the VA invalidate your suffering, or make it worse! Make an informed decision:
http://groups.msn.com/AftermathofwarcopingwithPTSDtoo/veteransalert.msnw?action=get_message&mview=0&ID_Message=31605&all_topics=0

[combatptsd]

Here's another thread about neuroleptics causing brain damage.
In my opinion, ptsd is an autonomic nervous system disorder. It does not make sense to me to take medication for ptsd that disrupts the nervous system. But I am not a doctor, just someone else who suffers from ptsd in the aftermath of war. I healed drug free. Cognitive behavioral therapy is as effective as medication. Biofeedback is the best, it retrains the autonomic nervous system to relax again. Talk therapy, and writing about the trauma helps too. Traumatic experiences happen so fast, they don't have enough time to be encoded into narrative memory. So, they present as a symptom. In time, your systoms will get better. Talking about it helps. God, I am so sorry this happened to you. You didn't deserve it. You do deserve to recover. Thank you for your service and sacrifices, thank you for surviving, and welcome home.

neuroleptics cause brain damage
http://groups.msn.com/AftermathofwarcopingwithPTSDtoo/general.msnw?action=get_message&mview=0&ID_Message=32513&LastModified=4675638309226657280

PTSD and the Pearl

War put a grain of sand in the soldiers heart,
The pain it caused tore his soul apart,
He writhed and squirmed as his agony grew,
Tragedy was the only thing he knew.

Loved ones watched his pain, they felt it too.

No one understood that grain of sand,
Or the purpose for the pain at hand.
Trying to rip that stone right from his heart,
Prevented healing from the start.

Loved ones watched his pain, they felt it too.
No one knew just what to do.

That grain of sand became a rock,
A hardened stone that some would mock.
Anger and numbness tried to conceal,
The pain that hurt too much to feel.

Loved ones watched his pain, they felt it too.
No one knew just what to do.
Soon their hearts too would turn to stone,
Suffering their pain alone.

Oh agony, what a heavy price to pay,
To thrash and cast that boulder away,
No one understood in order to heal,
Pain is a virtue we all must feel.

That grain of sand is growing now,
And our soldiers hearts are changed somehow,
But as each layer of pain unfurls,
Inside his heart, there lies a pearl.

That irritating little grain of sand,
Has grown to something we now understand.
His loved ones watched, they felt it too.
Now there's a pearl of wisdom inside of you.

A treasure to behold, not of shame,
PTSD is the survivors name,
The very thing we once have hated,
Is a thing of beauty war created.

Chris Woolnough
4/25/06