PTSD Medications?

[Captain.Heroin]

I wanted to post in here because of some fundamental questions I had, that I don't think OD would do well for.

http://en.wikipedia.org/wiki/Post-traumatic_stress_disorder#Medications

Looking at this, phenelzine looks like a good candidate for PTSD treatment and is listed for the following symptoms... Nightmares, Hyperarousal, "Sleep Disturbance" - Insomnia?, and Depression.

Now here is the interesting part - the list of medications for secondary symptoms... "self-mutilation; clonidine and buprenorphine" Is this why I fucking loved buprenorphine? Was it very medicinal for me in this sense? I do believe it was considering what I've been going through these last 34 days without buprenorphine.

I guess another question is - practically speaking, is phenelzine worth it? I would hate to die due to cheese or meth or something stupid like that. Too many interactions - but I have tried sertraline and absolutely hated it. I mean I liked it while I was on it, but it made me asocial, dissociating into my "own world" all the time, not wanting friends - I promptly realized this wasn't healthy and got off of sertraline (zoloft) for that reason.

All of this is me rambling and asking for advice, nothing advanced.

advanced question...

In addition, most people with PTSD also show a low secretion of cortisol and high secretion of catecholamines in urine,[60] with a norepinephrine/cortisol ratio consequently higher than comparable non-diagnosed individuals.[61] This is in contrast to the normative fight-or-flight response, in which both catecholamine and cortisol levels are elevated after exposure to a stressor.

and then.... in the same paragraph of the same article...

However, there is considerable controversy within the medical community regarding the neurobiology of PTSD. A review of existing studies on this subject showed no clear relationship between cortisol levels and PTSD. However the majority of reports indicate people with PTSD have elevated levels of corticotropin-releasing hormone, lower basal cortisol levels, and enhanced negative feedback suppression of the HPA axis by dexamethasone.

Let's say that my ratio of NE to cortisol is off the wall (I'm assuming this for theoretical discussion) .... what could I do, short of injecting cortisol, much like JFK with his Addison's disease? What the fuck else would I do? Any input is appreciated, much to the ADD community. I guess the other logical step - NE blocker/antagonist/etc??? I'm lost here.

Also,

Other studies indicate that people that suffer from PTSD have chronically low levels of serotonin which contributes to the commonly associated behavioral symptoms such as anxiety, ruminations, irritability, aggression, suicidality, and impulsivity.

and another quote I could get would also implicate dopamine is lacking.

I guess from these findings one can come to an understanding that DA, 5-HT, cortisol can be low, NE probably high, and each of these facets may or may not be present in someone with PTSD.

So really is it a "guessing game" where you do the drugs, you know what the drugs do, and you figure out your own endogenous neuropharmacology by seeing what works best? I see some of the "the lack of this causes these symptoms" - what if there is some crossover, etc.? I'm assuming there simply isn't away to just find out what drugs I should take before trying different ones, eh?

The reason why I ask all these questions is that I feel compelled to accept pharmaceutical medication for PTSD, and frankly, both psychiatrists I have seen just wanted to put me back on sertraline 8(.

I would "ask my doctor" but doctors can be kind of naive or assume the first line treatment always works - even when I am telling them I am unwilling to go back on it because of how aversive it was. 8( 8(

So any advice?

 

[arctica]

You might try getting your hands on Minipress/prazosin, which is an alpha-adrenergic blocker used for PTSD-related nightmares and night terrors. It didn't seem to have a huge impact on me personally, but it's one of the few drugs that I know of that seems to be prescribed specifically for PTSD symptoms. (While I don't have a trauma history, my anxiety/depression symptoms definitely seem to have a PTSD traumatic response "flavor," which is why they prescribed it for me.)

ETA: Here's a blurb on treating vets with PTSD with prazosin: http://www.research.va.gov/resources/pubs/docs/va_research_currents_apr_07.pdf

Prazosin works by blocking the brain’s response to the adrenaline-like neurotransmitter norepinephrine.

 

[MagickalKat777]

That drug sounds like it could be good for panic response as well.

 

[arctica]

That drug sounds like it could be good for panic response as well.

Inderal (propranolol) is a beta blocker that was originally used to treat hypertension, but also used frequently for panic/anxiety, especially for things like stage fright and fear of public speaking. It non-selectively blocks the action of epinephrine and norepinephrine on beta receptors. From Wikipedia, it sounds like it's being investigated for PTSD as well:

http://en.wikipedia.org/wiki/Propranolol

Propranolol is currently being investigated as a potential treatment for post-traumatic stress disorder.[12][13][14] Propranolol works to inhibit the actions of norepinephrine (noradrenaline), a neurotransmitter that enhances memory consolidation. Studies have shown that individuals given propranolol immediately after a traumatic experience show less severe symptoms of PTSD compared to their respective control groups that did not receive the drug (Vaiva et al., 2003)[full citation needed]. Propranolol reduces the effects of nightmare-related cardiac activity by keeping sinus rhythm low during nightmares, as a higher pulse and increased adrenaline are associated with severe nightmares. However, results remain inconclusive as to the success of propranolol in treatment of PTSD, including nightmares experienced by those with PTSD.
Ethical and legal questions have been raised surrounding the use of Propranolol-based medications for use as a "memory dampener," including: altering (memory-recalled) evidence during an investigation, modifying behavioral response to past (albeit traumatic) experiences, the regulation of these drugs, and others.[15] However, Hall and Carter have argued that many such objections are "based on wildly exaggerated and unrealistic scenarios that ignore the limited action of propranolol in affecting memory, underplay the debilitating impact that PTSD has on those who suffer from it, and fail to acknowledge the extent to which drugs like alcohol are already used for this purpose." [16]

I took propranolol in combination with benzos for years for panic/anxiety, but benzos seem to be more effective for me personally, so I eventually discontinued the propranolol. The good news is that prppranolol is reasonably safe (much safer than benzos), well tolerated, and has a fast onset of action.

 

[arctica]

@Captain.Heroin I feel you about the sertraline. It seems like shrinks sure do love their sertraline. I think I've completed perhaps 4 separate trials on sertraline, usually in combination with another antidepressant and/or augmentation agent. At doses around 50 mg I seem to notice some minor antidepressant benefit and can tolerate it reasonably well compared to some of the other stuff I tried. For me, it has always been inadequate in treating anything more than very mild anxiety and depression symptoms.

However, a "more is more" approach to sertraline dosing during one hospitalization at a well-respected institution in Belmont, MA ended disastrously when 200 mg sertraline (+450 mg Wellbutrin XL, 200 mg Seroquel, 50 mg Imitrex p.r.n + about 8 other drugs including Klonopin, Ambien, etc.) gave me serotonin syndrome. The fix was to take me off all 12 medications cold turkey and add them back one by one after the serotonin syndrome abated. I'm not sure if the SS or the withdrawals were worse, but overall, it was my worst drug experience ever. I believe the real issue was that both sertraline and Seroquel work on serotonin, 200 mg of sertraline is about 4x a normal dose, and my first symptoms of SS were an exacerbation of my migraines, which were treated with doses of Imitrex (which also works on serotonin) in increasing frequency. The end result was a forward feedback loop and eventual SS meltdown.

 

[Captain.Heroin]

Thanks for the advice everyone

Will limiting my norepinephrine cause any unwanted side effects? Like will it kill my drive, creativity, etc? Only one way to find out?

 

[arctica]

Thanks for the advice everyone

Will limiting my norepinephrine cause any unwanted side effects? Like will it kill my drive, creativity, etc? Only one way to find out?

I didn't notice any unwanted side effects from either drug (I think hypotension is the main concern from a physical standpoint on propranolol, prazosin has a usual suspects side effect list: headache, drowsiness, blurred vision, nausea, etc.). If they had any negative effects on my drive or creativity, they interfered much less than the effects of PTSD-like levels of anxiety on the same.

The interwebs tell me that Prazosin's half life is 2-3 hours and propranolol's half life is 3-6 hours, so if they do result in unwanted side effects, they will be gone quickly.

 

[arctica]

Jansen's Ketamine: Dreams and Realities (http://www.maps.org/books/K-DreamsKJansenMAPS.pdf) is a good read. It seems that ketamine came of age during the Vietnam war, and Jansen mentions that many vets returned to the U.S. with a different view on anesthetics. I've been curious about a possible connection between PTSD and ketamine, and wonder if soldiers who abused ket during and after Vietnam did so more for its dissociative properties or for its glutamate-quenching properties. From my own experience, I have a suspicion that ketamine would make a good treatment for PTSD.

For example, music used to be a huge part of my life. I was a musician, even. It feels like my brain got rewired, because I can't listen to music anymore without it generating a traumatic response, even random music on the radio that doesn't hold any particular significance. It's like the positive emotional response I previously experienced through music has been somehow inverted into a negative emotional response, and it's strong enough that I avoid it like a hot stove. I've been living in silence by choice for years now, as the alternative is too emotionally challenging to face. BUT, while on ketamine, I've noticed that I can listen to and enjoy music again. It seems like a long lost friend, no baggage, just pick up where I left off. Even music with personal significance that would have previously been an emotional minefield somehow seems possible. It's like I can relate to music in a non-traumatic way on ketamine.

Working backwards from the effects, I'm wondering if the alleviation of the traumatic response is through a reduction in glutamate, which is the major excitatory neurotransmitter in the brain.

Have you had any experience with NMDAR antagonists?

 

[endotropic]

Are you familiar with MAPS work using MDMA to treat PTSD?

http://www.bluelight.org/vb/threads...MDMA-Assisted-Psychotherapy-for-Treating-PTSD

I don't know how much help that will be to you unless you're located near one of their clinical trials, I don't think there's anything you could do at home that would replicate the psychotherapy that goes along with their drug therapy, but it's something to be aware of.

 

[arctica]

I can imagine MDMA being used therapeutically for PTSD outside of a traditional psychotherapeutic environment. My experiences on MDMA profoundly alleviated my agoraphobia, social anxiety, and feelings of shame and guilt, at least for a few hours. Subjectively, it felt like I had just gotten up out of a dentist's chair after wearing a lead apron for X-rays. After wearing the lead apron for a few minutes, you stop noticing that it's heavy until it's removed, and then you feel shockingly light and unburdened. I think that taking MDMA with a significant other or close friend might let someone with PTSD be able to start talking about difficult aspects of the traumatic event and its aftereffects in an empathic and supportive environment. I don't think it would be a great idea to use it on a regular basis for PTSD symptoms because your serotonin will be depleted for a few days afterwards, which could exacerbate the PTSD symptoms. Obviously, this is brainstorming and not treatment advice.

 

[ebola?]

Honestly, at this point, cognitive behavioral techniques seem way better suited to treatment of PTSD than the current pharmacopia, not that we've yet developed very good techniques yet.

I don't think there's anything you could do at home that would replicate the psychotherapy that goes along with their drug therapy, but it's something to be aware of.

I've had really bad luck taking MDMA with therapeutic designs without external guidance, though I've had MDMA sessions that were spontaneously therapeutic. YMMV, etc.

ebola

 

[Captain.Heroin]

Question; why aren't amphetamines (not MDMA; I don't see it as that useful for PTSD) being investigated as treatment for PTSD? Other than addiction potential?

I see them as having great potential for this disorder.

I still have yet to get on any medication for my PTSD. I'm still 100% opposed to sertraline.

 

[serotonin2A]

Question; why aren't amphetamines (not MDMA; I don't see it as that useful for PTSD) being investigated as treatment for PTSD? Other than addiction potential?

I see them as having great potential for this disorder.

I still have yet to get on any medication for my PTSD. I'm still 100% opposed to sertraline.

Methylphenidate is being investigated, and is probably a better option for most patients.

 

[Sophia2010]

I know you had started this thread awhile ago. Wondering if you have started anything yet for your PTSD? I'm a doctor of pharmacy that specializes in neuropsychpharmacology. Emphasis on PTSD, depressive and anxiety states, ADD, physical and emotional pain treatment with an additional year long fellowship working with chemical dependency treatment and research. More importantly, I suffer myself from PTSD that developed from multiple severe traumas over a short time span. After a year long battle trying to escape a dangerous relationship I ended up locating to the safety of a friends house in January 2014. I was already suffering problems due to this then on February 3rd, 2014 my 4yo daughter became suddenly ill and the illness took her life only six days later. I also became sick right before she passed away and I was taken to the ER where doctor negligence in my case caused me 4 continuous months in ICU on dialysis and plasmaphoresis daily. I also coded and almost lost my life twice. Since I've had over 17 additional hospitalizations over the following 2 years, permanent damage to my kidneys, and a number of other issues. Over the last 3 years, due to my background and experience I have researched and studied in great deal the current theories of treatments for trauma states, depression, mood disorders etc. My goal was to connect patterns within all the published research, examine how each neuropeptide, enzymes, cofactors etc relates to all processes in the body and look at everything in a fluid or changing sense vs static. The consequential event that occurs when receptors and ligands interact depends on numerous other variables and to say it's complex is an understatement. Based on my research, I've been personally able to try some various pharmacological treatment for my PTSD symptoms while also continuing to do some therapy such as CBT or DBT. If you still have any specific med questions I could tell you what I've found. Also, I'm curious if you have any updated experiences with medication either positive or negative that would be interesting.

 

[MorningGloryTrips]

I take prazosin, it gets rid of bad dreams, heart racing due to anxiety, and disassociating

 

[Captain.Heroin]

I won't take traditional meds.

α blockers would be acceptable to stop nightmares but no doctor will rx it to someone my age.

I just want to use meth. Why isn't it being investigated? Weight loss and ADHD shouldn't be the only approved uses.

 

[Captain.Heroin]

I won't go back on SSRI meds. Brain zaps are hell, and SSRI withdrawal also made me extremely suicidal.