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PTSD Treatment and Prognosis

By Dr. Karl Benzio MD

Page Overview

Post Traumatic Stress Disorder (PTSD) is a mental health anxiety disorder which is directly connected to events an individual experiences, namely events that were traumatic or stressful. It is important for someone to seek help processing an intense negative event as soon as the event occurs, but if not, and PTSD develops, they should pursue professional treatment as soon as possible.

You might be thinking: Is PTSD treatable? I can’t erase the past, so what can I really do about it or why should I get treatment? The answer is yes, PTSD is very treatable, and the prognosis is good for those who do seek help, and the earlier help happens, the better the outcome. No, you can’t change events that have happened in the past, but you can change the way you stored them and how you presently react to and feel about these events. Modifying your thinking while developing skills to manage the memories and ripples of that traumatic event will help you heal.

Do I need Treatment for PTSD?

If you suspect you have PTSD, you should definitely be evaluated by a psychologist or psychiatrist who can diagnosis your condition and provide treatment if necessary. If you have already been diagnosed, then yes, you should go seek a licensed psychotherapist (M.D. psychiatrist, PhD. psychologist, L.C.S.W. social worker, or L.P.C. professional counselor) for treatment. This is the best way to process what happened to you in the past and stop the way it interferes with your living in the present, allowing you to live a life free of fear, anxiety, and past baggage. PTSD symptoms will get worse over time if not addressed and treated, and often lead to a variety of other mental and physical health issues.

Treatment Therapies for PTSD

Treatment for PTSD requires a multifaceted approach, involving healing of the mind, body, and spirit. Some of these treatment methods overlap and work in connection with one another to produce complete healing.

Body – Medications. One way to treat PTSD is through the use of medications. Medications, when prescribed and closely monitored by a psychiatrist and taken as directed, are an effective, successful, and important complement to talk therapies (psychotherapies) that infuse psychological skills and spiritual truths. Medications don’t cure PTSD, but they temporarily repair or fix the damaged brain circuitry to alleviate the thinking, emotional, and physiological symptoms of PTSD so the individual can more effectively soak up and implement the talk therapies for a lasting healing to occur in their brain, mind, and life.

Some of the symptoms that are relieved: nightmares, flashbacks, anxiety, fear, insomnia, agitation, restlessness, depression, crying, impulsivity, easily distracted, forgetfulness, isolation, phobias or avoidance behaviors, heightened startle reflex, irritability, anger or tantrums, or loneliness, to name a few.

Antidepressants: Even though PTSD is an anxiety disorder, the antidepressants are the class of medications research shows to be most successful for alleviating PTSD symptoms. These need to be taken daily and will take several weeks for their effect on the brain circuits to be noticed as symptom relief.

  • Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed and these are Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram).
  • Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are less often used and occasionally helpful and include Effexor XR (venlafaxine XR), Cymbalta (duloxetine), and Fetzima (levomilnacipran).
  • Tricyclic Antidepressants (TCAs) are an older group but are still occasionally used and include Elavil (amitriptyline), Pamelor (nortriptyline), Tofranil (imipramine).
  • Other antidepressants occasionally used are Remeron (mirtazapine) and Desyrel (Trazadone), especially when insomnia or severe agitation are present.

Anti-anxiety medications: Often, while waiting for the antidepressants and talk therapy to take hold and have their longer term therapeutic effect, medications to help acutely with the extreme anxiety are often used and helpful.

  • Benzodiazepines, or tranquilizers, relieve anxiety within 20 minutes and are very effective. For some, though, they can be addicting, so care and caution are vital to maximize their benefit and minimize them becoming problematic. Common ones are Ativan (lorazepam), Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), or sleeping pills like Halcion (triazolam), Restoril (temazepam), or Ambien (zolpidem).
  • Anti-seizure medications often help with anxiety, mood, and impulsivity and include Neurontin (gabapentin), Trileptal (oxycarbamazepine), Topamax (topiramate), Gabitril (tiagabine).
  • Antipsychotic medications or major tranquilizers for severe anxiety and insomnia, the following medications can bring acute relief: Seroquel (quetiapine), Mellaril (thioridazine), Zyprexa (olanzapine), and Abilify (aripiprazole).
  • Others like Buspar (buspirone) for anxiety or Minipress (prazosin) for nightmares are helpful in more difficult cases.
  • Medicines for other physical issues caused by or worsened by PTSD such as high blood pressure, heartburn, stomach ulcers, muscle pain, headaches, sexual issues, asthma, psoriasis, fibromyalgia, reflex sympathetic dystrophy, irritable bowel syndrome, and many other stress related or worsened illnesses.

 

Mind – psychotherapies. In recent decades, several psychotherapies have emerged that are proving effective for treating the PTSD symptoms and the underlying root causes. These therapies are beneficial for other types of behavioral and mental health disorders as well. Often successful therapy incorporates several of these therapies in an integrated or fluid way.

Cognitive and Emotion therapies. Cognitive Behavioral Therapy (CBT) and its relatives, Dialectical Behavioral Therapy (DBT), Emotion Focused Therapy (EFT), and Rational Emotive Behavior Therapy (REBT) are forms of talk therapy which help individuals become better aware of their internal world, identify thoughts and feelings more accurately, and change incorrect thought patterns. The idea behind these therapies is PTSD emerged from our difficulty processing a past event and the many distortions that were planted in our mind because of it. If we can reach into our mind and change the way we perceived and processed that past event, we can change how we currently feel as well as how we react to similar situations. We can’t change the past event, but this helps us process the past event, correct the damage from it, and not let it pull us down so we can be freed from how it negatively impacts our life.

Exposure therapy. This method of psychotherapy helps individuals face their fears and learn how to cope with situations that remind them of their past trauma and frighten them. This therapy is sometimes used with virtual reality programs or guided imagery which in some way expose the patient to the same kind of traumatic situation they initially faced in order to help them achieve a better, more peaceful resolution in their mind to the event.

Eye Movement Desensitization and Reprocessing (EDMR). This type of exposure therapy has the patient follow the clinician’s finger with their eyes. These eye movements stimulate memory circuits in our brain to allow for easier remembering and especially re-processing of past memories to change the reaction the patient has to stressful memories as well as similar present day events.

Spirit – Biblical truths, beliefs, and life management principles. Finally, and most importantly, we can’t forget the spiritual sphere to our human identity and experience, and its impact on overall health. In order to really treat a condition like PTSD, the individual’s spiritual identity and wellbeing must be addressed. Relying on the power of God and His forgiveness, grace, and love, we can enjoy renewal and the hope it brings. Including Christian treatment principles allows the individual to see themselves not as someone who has been through a certain event, but as someone loved and chosen by God to live a life according to His will and then knowing all things work together for good for those who love God and are called according to His purposes (Romans 8:28). Investigating and applying spiritual truths and principles to understand our lives creates structure for a renewed life of peace, hope, and joy.

We dedicate the next 2 pages, page 4 and page 5, of this guide to discuss the importance of spiritual healing for PTSD.

What Happens if I Don’t get Treatment?

Conditions like PTSD have such far-reaching effects that if not treated, can cause other health issues – physical, emotional, and even spiritual disruption and dysfunction. Common ripples associated with PTSD include a number of significant behavioral health disorders which we will discuss in more depth in page 6 of this guide and the many spiritual struggles we will discuss in page 8.

Sadly, PTSD stress and the excess adrenaline produced has significant impact on all our physiological systems and some common physical disorders associated with PTSD are the following:

  • Hypertension
  • Heart disease
  • Heartburn or Reflux
  • Irritable Bowel Syndrome
  • Crohn’s Disease
  • Stomach Ulcers
  • Headaches
  • Back and joint issues
  • Pain syndromes
  • Sexual Pain
  • Sexual impotence
  • Cancers
  • Endocrine (hormonal) issues
  • Endometriosis
  • Thyroid problems
  • Immune system issues
  • Stress worsened disorders
  • Asthma
  • Psoriasis
  • Chronic infections
  • Reflex Sympathetic Dystrophy
  • Chronic Fatigue
  • Fibromyalgia
  • Diarrhea
  • Obesity
  • Certain Arthritis Conditions
  • Psychosomatic disorders

Getting Treatment for PTSD

Many treatment providers around the country help people overcome PTSD. Treatment options occur in the form of outpatient therapy, where the individual attends therapy sessions ranging from one time per week to daily for 3-5 hours per day for several weeks, but lives at home while receiving treatment. For those whose PTSD has progressed to a more distressing or disruptive level, residential treatment is safer and brings quicker relief and return to functioning. During residential treatment, the individual will live at the treatment facility, participating in therapy sessions throughout the day and evening. Residential treatment allows the PTSD sufferer to live in a safe and secure facility, sheltered from the outside stressors, while receiving intensive treatments as described above.

Long-term prognosis for PTSD sufferers is very good when the person gets help. The following treatment ingredients maximize the healing process and outcome:

  • Treatment to start as soon as possible after the traumatic event,
  • Higher intensity or frequency of treatment,
  • Psychological depth of the treatment,
  • Spiritual depth of treatment,
  • Expertise of therapist

By creating awareness for PTSD, we can encourage individuals to seek help before PTSD symptoms even begin, so they can process the traumatic event effectively and spare themselves the pain and suffering associated with this sad but common disorder.