Three Types of Medications Used to Treat PTSD

When it comes to prescribing a medication, your doctor has quite a selection to choose from. Here’s a quick look at the primary medications commonly used to treat the symptoms of PTSD.

Antidepressant

They literally mean “to eliminate depression”, but actually it is quite misleading, antidepressant work by reducing your anxiety level and also to control your hair-trigger reactions. As matter of fact, antidepressants usually work better at controlling anxiety than drugs specially intended to deal with anxiety disorders. There are a few types of antidepressants, each works in different way and has different drawbacks and advantages.

Selective Serotonin Reuptake Inhibitors

They are currently the primary medication for treating PTSD, despite the complicated name, the meaning is quite straightforward:

Selective: It affects only a single messenger chemical.

Serotonin: It only affects serotonin, one of the neurotransmitters used by brain cells (neurons) to communicate. Serotonin is a key chemical that can affect impulsiveness, aggression, anxiety levels and mood – and also many physical activities including indigestion and sleep.

Reuptake: A condition when many neurons fail to link up with other neurons, as the result neurotransmitters (serotonin, in this case) return to the originating neurons.

Inhibitor: The drug prevents the reuptake process by stimulating neurotransmitters to work harder in reaching other neurons.

According to researches, SSRIs are very effective in minimizing PTSD symptoms. Many patients have responded well after using the drugs in just two weeks, although some patients need 3 months or more to feel better. Unfortunately on certain patients, antidepressants can cause impulses, increase depression and induce suicidal thoughts (usually in younger people). As the result, doctors need to continuously observe the patient’s development after prescribing SSRI drugs. However, the jury is still out on whether antidepressants can elevate suicide risks. Additionally, SSRIs can lower sex drive and cause other side effects, when combined with drugs that increase the serotonin production, the effect can be disastrous. Serotonin syndrome is a condition when patients have too much serotonin, which can adversely affect body temperature, heart functions and other important physical processes. Although SSRIs drugs are not addictive, stopping the medication abruptly may cause troubling withdrawal effects. Common SSRIs drugs are paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox).

Serotonin and Norepinephrine Reuptake Inhibitors

Just like SSRIs, SNRIs can also increase the serotonin activity in our brain. However, other than serotonin, SNRI drugs can also affect norepinephrine, which has an important role in alertness and arousal. Just like SSRIs, SNRIs can also stop brain cells from recalling neurotransmitter when link-up fails. SNRIs are often considered as a more powerful alternative to SSRIs for treating PTSD, when the SSRIs just don’t do the trick. Although SNRIs are powerful, they have a wide range of negative effects ranging from weight gain and insomnia to low sexual drive. The side effects vary according to the brand you take. Common SNRIs are duloxetine (Cymbalta) and venlafaxine (Effexor). However, duluxetine doesn’t seem to be effective in treating PTSD.

Tricyclics

They are among the earliest antidepressant and still in use today. However, tricyclics are falling out of favor due to many side effects that can occur, such as blurred vision, drowsiness, headaches and confusion. Similar to SNRIs, tricyclics work by boosting norepiphrene and serotonin levels. In addition, tricyclics can also increase the dopamine level. Other than preventing neurotransmitter reuptake, tricyclics can also block some cell receptors, which is the reason for so many side effects. Tricyclics are considered more powerful than both SSRIs and SNRIs; and currently given only to those who are not responding to SSRIs and SNRIs. Common tricyclics include nortriptyline (Pamelor), amitriptyline (Elavil), imipramine (Tofranil) and desipramine (Norpramin).

MAO Inhibitors

As the name suggests, these drugs inhibit monoamine oxidase (MAO) from performing its function, which is to suppress monoamine neurotransmitters – epinephrine, norepinephrine, dopamine and serotonin. As the result, there will be greater levels of neurotransmitter in the brain. Common MAOIs show many side effects and interact with certain alcoholic beverages and cheese. Those beverages and cheese contain a good deal of tyramine, important amino acids for our health, but can be harmful when present in large quantity. Monoamine oxidase can’t break down tyramine when MAOI drugs are taken. Due to these issues, MAOIs are now rarely prescribed to treat PTSD. However, a new form of MAOI called Emsam (selegiline) is approved by the FDA when prescribed as low-dose patches. The new drug doesn’t interact with tyramine-rich foods and has far fewer side effects compared to traditional MAOIs. The reason is, because it blocks Type-A MAO and leaving Type-B available to break unwanted chemicals down.

Anti-Anxiety Drugs

Buspirone (Buspar) and benzodiazepines are common anti-anxiety drugs used to treat PTSD. One is slower but safer and the other quick and can be risky.

Buspirone (Buspar): It works slowly and has full effects only after 2 to 4 weeks. It triggers relatively few side effects and can reduce nightmares and intrusive thoughts. Little is known about its working process, but it appears to affect the serotonin.

Benzodiazepines: They act by enhancing the gamma aminobutyric acid effects, which lowers the nerve cells excitability. These drugs work rapidly and may ease sleep problems and anxiety within days. However, some patients may become quickly dependent on them and withdrawal symptoms can be intense. Benzodiazepines are prescribed only if anti-depressants have little effects on the patients. These drugs can cause aggression, memory loss and sleepiness. Some patients may also lose coordination, which make it dangerous to drive and operate heavy machineries. Common benzodiazepines are temazepam (Restoril), oxazepam (Serax), lorazepam (Ativan), triazolam (Halcion), chlordiazepoxide (Librium), clorazepate (Tranxene), alprazolam (Xanax), clonazepam (Klonopin), flurazepam (Dalmane) and diazepam (Valium).

Beta-Blockers

These drugs are among the most exciting developments in PTSD treatments, because they may address traumatic memory issues. Beta-blockers are originally hypertension medication with good safety profile and long track record, although they shouldn’t be prescribed on people with certain cardiovascular problems. They block beta receptors on brain, heart and other organs and prevent adrenaline from stimulating the process. A type of beta-blocker, propranolol, can prevent PTSD by stopping memories from setting. Additionally, people with long-term PTSD symptoms sometimes report that these drugs can calm rapid breathing, pounding heart and stress symptoms.

In an experiment, patients are asked to recall a traumatic scene and then immediately given propranolol. The aim is to prevent the patient from re-storing negative memories. The process may eventually cause memory decay and this therapy may ward off symptoms of PTSD for months only with a single dose.

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