Try exposure therapy, SSRIs for PTSD

There's no cure for posttraumatic stress disorder, but helping its sufferers reduce symptoms,improve resistance, and achieve an improved energy levels and overall health can be possible.

�We don't know precisely what the best treatments are for PTSD,� Dr. Charles B. Nemeroff, theLeonard M. Miller Professor, and chairman of a given department of psychiatry and behavioralsciences at the University of Miami, told additional visitors at the annual psychopharmacologyupdate held by the Nevada Psychiatric Association.

If you want to rely on psychosocial or pharmacologic interventions, or a combination of the twomain, to help shift PTSD typically from debilitating condition into a manageable, chronic one, it isrecommended to understand PTSD being a brain disease. �To accurately treat PTSD, think it overwithin a neurobiological context,� Dr. Nemeroff said. �Ordinarily, our brain is evolved tocontend with stress, but it often is compromised.�

In chronic PTSD, brain research projects have shown a noted shrinkage inside the hippocampus,furthering memory impairment, clone of the reduced hippocampal volume in child-abuse victims.Additionally, cortical function in the brain is affected in PTSD, creating difficulty with exercisingjudgment and good decision making.

�One way to carefully consider PTSD is the fact that the cortex has difficulty to reign inside thelimbic system,� Dr. Nemeroff said. �The hippocampus is impaired, the amygdala is hyperactive,and there s a tremendous emotional drive, which means that �thinking� section of the braincan�t [overcome] the emotional, reptilian brain.�

The end is that a person remains stuck in a hyperaroused state. �We know that theneurobiological reason for PTSD involves a prolonged, vigilant reaction to stress [involving] a largenumber of brain circuits ... and of course the sympathetic deep nerves it lurks in as well as havingthe pituitary and adrenal systems,� Dr. Nemeroff said.

Beyond brain changes, a genetic predisposition to PTSD makes up a 3rd of all cases, while anadditional one-third are owing to additional biological aspects, according to Dr. Nemeroff (Nature2011;470:492-7).

Really as with anxiety-related disorders, women tend to be more PTSD susceptible than are men.Possibly one of the �few things everybody agrees on,� Dr. Nemeroff said, is early-life trauma forinstance neglect or abuse is naturally a definite factor for PTSD, partially because early-life stress isbelieved to permanently program the brain regions involved with stress- and anxiety-mediation.Additionally to this, any adult level trauma, and then they will two �synergize. The moreconsistently adult trauma coupled with early childhood abuse or neglect, the greater the degree ofPTSD.�

Meanwhile, poor social support, especially when occurrence of a traumatic event, is a traditionalprognosticator of poor recovery from PTSD, as are kids tradition of mood disorders, lower I.Q. andeducation, and experiencing other stressors the entire year before or after a traumatic event.

Dr. Nemeroff said that while the goals of treatment are reduced core symptoms, improved quality oflife work, strength, and resilience against subsequent stress, �the sad fact of the matter may be

that we don�t have a very clue exactly what the best treatment is, because we do not have anypredictors of treatment response for PTSD.�

Most typical treatments for PTSD are selective serotonin reuptake inhibitors (SSRIs), even thoughbest data available tell that prolonged imaginal exposure therapy would be the best, Dr. Nemeroffsaid. It may be provided either virtually along with person, and includes breathing techniques,psychoeducation, and cognitive therapy. The Institute of drugs gives exposure therapy its highestrating for scientific evidence, said Dr. Nemeroff, who is a board membership owner the institute.

Pharmacologic treatments approved by the Food and Drug Administration for PTSD treatmentinclude sertraline and paroxetine, although other antidepressants can easily be prescribed off-labelto a certain effect.

With sertraline, there really is a �pretty low bar� of efficacy, in accordance with Dr. Nemeroff,since simply a 30% improvement in symptoms was recorded in 60% of study participants for FDAapproval. It�s vital that you remember the treatment-response in PTSD is far not as fast as inmajor depression, Dr. Nemeroff said. �It usually takes equally as much as 9 months, so don�tgive up.�

Combining sertraline with prolonged exposure therapy is more successful, he explained (J. TraumaStress 2006;19:625-38). Meanwhile, other data show what paroxetine alone performed more thanplacebo, however the data are mixed for the drug in combination with prolonged exposure therapy(Am. J. Psychiatry 2012;169:80-8), (J. Clin. Psychiatry 2008;69:400-5), (J. Clin. Neurosci.2008;62:646-52), and (Am. J. Psychiatry 2001;158:1982-8).

Dr. Nemeroff said lately, they have been treating PTSD patients with venlafaxine 450 mg, whichhappens to be much higher than the usual dose of around 220 mg, with �considerably goodresults� (Arch. Gen. Psychiatry 2006;63:1158-65).

Improvements in memory and hippocampal volume generally are found with SSRI treatments, inaddition to reductions in symptom severity, in accordance with Dr. Nemeroff.

For PTSD patients who are struggling with insomnia and other sleep-related problems, Dr. Nemeroffsaid prazosin is �phenomenal,� especially in reducing nightmares (Am. J. Psychiatry2013;170:1003-10).

One drug class to avoid using with PTSD patients is benzodiazepines, he explained. �Every studyhas been shown that benzodiazepines in PTSD do not work, and that they contain a high rate ofsubstance abuse in this particular population.�