Post traumatic stress disorder (PTSD) can cause disabling symptoms that persist for years in some people who have experienced severe trauma. In a recent entry, I discussed the symptoms and impact of PTSD. Here, I'll review some treatment issues.
Just a few months ago, the Institute of Medicine (IOM) of the National Academies of Science evaluated the published evidence about therapies for PTSD. They identified 90 clinical research studies that had dealt with PTSD subjects and whose research design had included appropriate random samples and control groups. Among these were both psychotherapy and pharmacotherapy studies.
Perhaps not surprisingly, they found that many entirely different types of medications and psychotherapies have been evaluated in people suffering with PTSD. Among the drugs were various antidepressants, anti-anxiety medications, anti-psychotics, sedative-hypnotics, and a blood-pressure medication (prazosin) that can decrease excessive neurotransmitter stimulation in the brain.
The varieties of psychotherapy and behavioral approaches investigated for PTSD included exposure therapy, cognitive restructuring, coping-skills training, group-format psychotherapy, and eye-movement desensitization and reprocessing.
Intriguingly, in spite of all of this research on PTSD, the IOM study group concluded that even all these studies were inadequate to allow them to conclude which treatments work reliably for PTSD patients. For the psychotherapy strategies, they did find that the evidence supported the use of exposure techniques.
As for the medications, however, there was insufficient evidence to conclude that any were reliably effective. Note that the IOM did not claim that the medications and therapies did not work, but rather that adequate proof was lacking. The IOM's key conclusion was that more research in this area is necessary.
The selective serotonin reuptake inhibitor (SSRI) antidepressants are the medications most commonly prescribed for PTSD patients. In fact, the U.S. Food and Drug Administration has officially approved 2 SSRIs (paroxetine and sertraline) for this disorder.
The U.S. Veterans Administration also recommends the SSRI antidepressants as first-line treatments for patients with PTSD. As with many psychiatric disorders, the combination of medications and psychotherapy techniques seems to work best with PTSD patients.
Are you wondering whether someone you know might have PTSD? Here's a quick questionnaire called the Primary Care PTSD Screen:
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you...
- Have had nightmares about it or thought about it when you did not want to?
- Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
- Were constantly on guard, watchful, or easily startled?
- Felt numb or detached from others, activities, or your surroundings?
Three "yes" responses are considered positive and suggest possible PTSD; consultation with a mental health professional should be considered.