Post traumatic stress disorder (PTSD) refers to the delayed reaction, sometimes for longer than 6 months, to a highly stressful or life threatening event. Often the causes for PTSD are myriad and distasteful, and more than 40 million women in America suffer from it. Although childhood abuse and sexual abuse is a common cause of PTSD, other events which cause psychological trauma can also trigger the disorder. These include life threatening accidents, wars or natural disasters.
PTSD usually occurs following a stressful or traumatic event that is highly severe, and often survivors and witnesses of such events will only start showing symptoms of PTSD after a few months. The reasons for this would be due to the event being perceived as dangerous and outside of the individual’s control, leading to feelings of helplessness and extreme anxiety.
Due to the severity of the event or disaster, the inability of the person to avoid or cope with the trauma is such that it results in PTSD. Due to the immense negative impact, the person will avoid any situation or trigger that might remind them of the event. Whilst it has been attributed to internal conflict, recent research has shown that these psychological conditions are actually due to past traumatic events. Further, it is likely that the extreme stress experienced during the event has resulted in physical damage to the hippocampus, the part of the brain that deals with the emotions of fear and stress.
For a person who is suffering from PTSD, any spur of event occurring can trigger manifestations and he will suffer from the traumatic event both physiologically and psychologically. There will be repeated flashbacks of the event, and being subjected to this experience will cause a behavioral change eventually. These take the form of amnesia, listlessness and a need to isolate themselves.
For children suffering from PTSD, they are likely to experience nightmares, memory fragmentation, hypertension, flashbacks, amnesia, panic attacks and some may turn to substance abuse to avoid memories of the event. Most victims will suffer from a range of effects, such as physiological, psychological, social and self destructive behaviors.
Physiological outcomes take the form of a change in the brain activity, structure and functioning, also known as neurobiological effects. There may also by psychophysiological effects, such as hyper arousal, increased propensity to be startles and increased neurohormonal changes which leads to greater stress and depression. It is often easy to overlook physiological outcomes as they take the form of physical issues such as headaches or lightheadedness and are treated accordingly.
Psychological outcomes include depression, anxiety disorders, eating disorders and dissociation, where the individual seeks to hide from the present by submerging into their selves. Other social indicators include low self esteem, substance abuse and an inability to form interpersonal relationships. At its extreme, the individual may turn to self destructive behavior and attempt suicide, or take part in self injury and risky behaviors that can lead to death.
If the individual is diagnosed with PTSD, there is treatment and help available in the form of stress medications and therapy. These aim to correct the physical, physiological and psychological effects experienced and aim to integrate the person back into their current lives.
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Painkiller Addiction and Dependency: What Your Body Is Telling You
Many people who suffer from Prescription Painkiller Dependence and Addiction don't abuse other drugs. In fact , some have never even tried drugs like marijuana before. Yet they are addicted to painkillers... but not by choice. For one reason or another, they were prescribed a painkiller such a Vicodin, Oxycontin, Oxycodone, Darvocet, or Percocet to alleviate pain caused by a fall, an injury at work, a car accident, or as part of post-operation treatment. But suddenly their prescription runs out, yet they're still in pain. Now what?
This is all too often the way people become addicted to prescription drugs. Their bodies develop a dependence on the drug to the point where it is too painful to stop taking it. It becomes a vicious cycle, and is devastating for both the user, and those around him or her.
Painkillers are opiates, producing a mild euphoric feeling that can help relieve pain. This is a blessing for those who suffer from conditions like fibromyalgia or herniated discs of the spine. But , as the person continues taking the medication , the opiates change the integrity and function of the brain and the way it reacts to pain. Opioids also change the way a person experiences pleasure. When the medication is stopped, these feelings go away, and a person can rebound.
A person will sometimes feel even more pain when he or she stops taking the medication. This isn't always the case, and much of that depends on a person's brain and body chemistry, as well as how long the medication was taken. People sometimes report depression when they stop taking their medication as well.
For those who are experiencing Symptoms of Vicodin Withdrawal and Oxycontin Withdrawal Symptoms often times the symptoms are too painful and difficult to deal with, so the user returns to taking the medication , even if it means obtaining it illegally. Even though it's illegal, people don't feel there's as much of a stigma associated with prescription drug abuse. After all, it's a drug they were initially prescribed, and if it was prescribed by a doctor, it must be safe compared to drugs like ecstasy and heroin obtained on the street.
If you've struggled to quit taking a medication because the effects are too devastating and painful, or if you are taking a painkiller beyond its intended medicinal use, you may be suffering from prescription painkiller dependency - in other words, your body is addicted.
There are many Painkiller Abuse Treatment Centers in Florida and in the U. S. to help people safely detox from prescription painkillers, and learn to cope with their body's addictions. These centers even offer out-patient treatment programs so you can continue to work and not disrupt your life.
Even working professionals suffer from these types of problems, yet often times they are too embarrassed or afraid to admit they have a problem. But once the stigma is dropped, and a person accepts that there is a problem, then the healing can begin.
You didn't become addicted by choice, but your body did, and it's telling you something: now is the time to get help.
This is all too often the way people become addicted to prescription drugs. Their bodies develop a dependence on the drug to the point where it is too painful to stop taking it. It becomes a vicious cycle, and is devastating for both the user, and those around him or her.
Painkillers are opiates, producing a mild euphoric feeling that can help relieve pain. This is a blessing for those who suffer from conditions like fibromyalgia or herniated discs of the spine. But , as the person continues taking the medication , the opiates change the integrity and function of the brain and the way it reacts to pain. Opioids also change the way a person experiences pleasure. When the medication is stopped, these feelings go away, and a person can rebound.
A person will sometimes feel even more pain when he or she stops taking the medication. This isn't always the case, and much of that depends on a person's brain and body chemistry, as well as how long the medication was taken. People sometimes report depression when they stop taking their medication as well.
For those who are experiencing Symptoms of Vicodin Withdrawal and Oxycontin Withdrawal Symptoms often times the symptoms are too painful and difficult to deal with, so the user returns to taking the medication , even if it means obtaining it illegally. Even though it's illegal, people don't feel there's as much of a stigma associated with prescription drug abuse. After all, it's a drug they were initially prescribed, and if it was prescribed by a doctor, it must be safe compared to drugs like ecstasy and heroin obtained on the street.
If you've struggled to quit taking a medication because the effects are too devastating and painful, or if you are taking a painkiller beyond its intended medicinal use, you may be suffering from prescription painkiller dependency - in other words, your body is addicted.
There are many Painkiller Abuse Treatment Centers in Florida and in the U. S. to help people safely detox from prescription painkillers, and learn to cope with their body's addictions. These centers even offer out-patient treatment programs so you can continue to work and not disrupt your life.
Even working professionals suffer from these types of problems, yet often times they are too embarrassed or afraid to admit they have a problem. But once the stigma is dropped, and a person accepts that there is a problem, then the healing can begin.
You didn't become addicted by choice, but your body did, and it's telling you something: now is the time to get help.
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Pharmacotherapy of Combat-stress-related Post Traumatic Stress ...
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By Harpriya A. (Sonya) Bhagar, MBBS and Alan D. Schmetzer, MD, Fellow of the American Psychotherapy Association, and Master Therapist
A number of veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) are returning home with signs of combat-stress-related Post Traumatic Stress Disorder (PTSD). In a recent study, 16. 6% of the soldiers met the screening criteria for PTSD. On average, they showed a significant increase in sick visits, missed workdays, severity of somatic symptoms, and poorer overall health (Hoge et al., 2007). In another study, the youngest age group, 18–24 years, was at greater risk compared with veterans 40 years of age or above. Diagnosis was made early (median of 13 days), and most of them were detected in primary care clinics (Seal et al., 2007).
Upon return from the war zone, veterans frequently report intrusive thoughts, flashbacks, increased vigilance, avoidance of social situations, hyperarousal, and nightmares. Treatment involves integration of mental health, primary care, physical medicine, attention to substance abuse, and vocational services. The mental health portion involves an initial screening of the combat veteran for PTSD and other mental illnesses, followed by a full assessment. Both pharmacotherapy and psychotherapy (individual, couple, and group) are offered for treatment.
From a pharmacological perspective, several studies have found the traditional anti-depressants effective in PTSD. Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft®), paroxetine (Paxil®), and fluoxetine (Prozac®), have been studied extensively for PTSD, and sertraline and paroxetine have been approved by the Food and Drug Administration for PTSD. SSRIs have been found to be effective both in short-term trials and long-term maintenance treatment for relapse prevention (Asnis et al., 2004). However , earlier studies have focused mainly on PTSD secondary to interpersonal trauma in a civilian setting. In a multicenter study, venlafaxine extended release (Effexor XR®), a serotonin norepinephrine reuptake inhibitor, was found to improve both the re-experiencing and the avoidance symptoms of PTSD, but not hyperarousal. The drug was effective and well tolerated in both short-term and continuation treatment of PTSD (Davidson et al., 2006). In a small study, mirtazapine (Remeron) was found to be effective in both short-term and continuation treatment of combat-stress-related PTSD without any serious side effects (Kim et al., 2005). In addition , sedation from mirtazapine can even prove beneficial in improving sleep in PTSD. In a randomized trial comparing phenelzine (a monoamine oxidase inhibitor) and imipramine (a tricyclic antidepressant), both significantly reduced combat stress related PTSD symptoms (Kosten et al., 1991). Benzodiazepines are used in PTSD for panic attacks or anxiety states. They provide temporary relief but run the risk of tolerance and addiction.
Veterans with PTSD find it hard both to fall asleep and to maintain sleep due to hyperarousal and vivid nightmares related to combat. Significant others often report that patients scream in their sleep and may even wake up soaked in sweat. Prasozin and clonidine both decrease the central nervous system’s noradrenergic activity. They have been found to be effective in decreasing hyperarousal symptoms and improving sleep (Boehnlein, 2007). Other drugs used for sleep are the benzodiazepine class of drugs, like temazepam, and non-benzodiazepines, like zolpidem (Ambien™) and ezopiclone (Lunesta™). However , caution must be taken regarding the habit-forming potential of these drugs (Bhagar and Schmetzer, 2006).
The presence of psychotic symptoms in PTSD can further complicate the clinical picture. In one study, 20% of the 91 males with combat-stress-related PTSD were found to be suffering from hallucinations and delusions, and hyperarousal was positively associated with the occurrence of psychotic symptoms (Kastelan, 2007). In a small study, augmentation of SSRI with olanzapine (Zyprexa), an atypical antipsychotic, was effective in treating SSRI-resistant combat-related PTSD symptoms, especially sleep (Stein, 2002). In another study, monotherapy with typical or atypical antipsychotics, reduced both PTSD and psychotic symptoms, and antipsychotics seemed to offer another approach to treat the psychotic subtype of combat–related PTSD resistant to previous antidepressant therapy (Pivac, 2006).
Overall, PTSD pharmacotherapy involves several drugs based on our experience with PTSD in general, but well-designed studies are needed to establish treatment guidelines specifically for combat-stress-related PTSD.
References
Asnis, G. M., Kohn, S. R., Henderson, M., & Brown, N. L. (2004). SSRIs versus non-SSRIs in post traumatic stress disorder: an update with recommendations. Drugs, 64(4), 383–404.
Bhagar, H. A., & Schmetzer, A. D. (2006). The newest medicines for sleep. Annals of American Psychotherapy Association, 9(2), 25–26.
Boehnlein, J. K., & Kinzie, J. D. (2007). Pharmacologic reduction of CNS noradrenergic activity in PTSD: The case for clonidine and prazosin. Journal of Psychiatric Practice, 13(2), 72–78.
Davidson, J., Baldwin D., Stein, D. J., Kuper, E., Benattia, I., Ahmed, S., et al. (2006). Treatment of post traumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Archives of General Psychiatry, 63(10), 1158–1165.
Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of post traumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164(1), 150–153.
Kastelan, A., Franciskovi,? T., Moro, L., Roncevic-Grzeta, I., Grkovic, J., Jurcan, V., et al. (2007). Psychotic symptoms in combat-related post traumatic stress disorder. Military Medicine, 172(3), 273–277.
Kim, W., Pae, C. U., Chae, J. H., Jun, T. Y., & Bahk, W. M. (2005). The effectiveness of mirtazapine in the treatment of post-traumatic stress disorder: A 24-week continuation therapy. Psychiatry and Clinical Neurosciences, 59(6), 743–747.
Kosten, T. R., Frank, J. B., Dan, E., McDougle, C. J., & Gille, E. L., Jr. (1991). Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. Journal of Nervous and Mental Disease, 179(6), 366–370.
Martényi, F. (2005). [Three paradigms in the treatment of posttraumatic stress disorder]. Neuropsychopharmacol Hung, 7(1), 11–21.
Pivac, N., & Kozari? -Kovaci,? D. (2006). Pharmacotherapy of treatment-resistant combat-related posttraumatic stress disorder with psychotic features. Croatian Medical Journal, 47(3), 440–451.
Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: mental health disorders among 103, 788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167(5), 476–482.
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