Jones & Bartlett Learning Medicine Blog

    Clinician's Guide to Medications for PTSD

    Posted by Jennifer Sharp on Jun 4, 2013 3:35:28 AM

    Re-posted from the United States Department of Veterans Affairs: Clinician's Guide to Medications for PTSD

    Overview

    Posttraumatic Stress Disorder (PTSD) has biological, psychological, and social components. Medications can be used in treatment to address the biological basis for PTSD symptoms and co-morbid Axis I diagnoses. Medications may benefit psychological and social symptoms as well. While studies suggest that cognitive behavioral therapies such as prolonged exposure (PE) and cognitive processing therapy (CPT) have greater effects in improving PTSD symptoms than medications, some people may prefer medications or may benefit from receiving a medication in addition to psychotherapy.

    Placebo-controlled double-blind randomized controlled trials are the gold standard for pharmacotherapy. Less strongly supported evidence includes open trials and case reports. It is important for the clinician to question the level of evidence supporting the medications prescribed in PTSD treatment. There are a variety of factors influencing prescribing, including marketing, patient preferences, and clinical custom, all of which can be inconsistent with the evidence base.

    Currently, the evidence base is strongest for the selective serotonin reuptake inhibitors (SSRIs). The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil) (1, 2). All other medication uses are off label, though there are differing levels of evidence supporting their use. In addition to sertraline and paroxetine, there is strong evidence for the SSRI fluoxetine (Prozac) and for the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) which are considered first-line treatments in the VA/DoD Clinical Practice Guideline for PTSD. There are a number of biological changes which have been associated with PTSD, and medications can be used to modify the resultant PTSD symptoms. Veterans whose PTSD symptoms have been present for many years pose a special challenge. Studies indicate they are more refractory to the beneficial effects of medications for PTSD symptoms (3).

    What core PTSD symptoms are we trying to treat?

    The three main PTSD symptom clusters are listed below:

    • Re-experiencing. Examples include nightmares, unwanted thoughts of the traumatic events, and flashbacks.
    • Avoidance. Examples include avoiding triggers for traumatic memories including places, conversations, or other reminders. The avoidance may generalize to other previously enjoyable activities.
    • Hyperarousal. Examples include sleep problems, concentration problems, irritability, increased startle response, and hypervigilance.
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    Topics: awareness, patient education, mental health, psychiatry, General Medicine, PTSD, Pyschiatry & Mental Health, veterans, posttraumatic stress disorders

    Capgras Syndrome: Ever Thought Your Loved One Was an Impostor?

    Posted by admin on Jul 11, 2011 12:38:48 PM

    Reposted from Huffington Post:
    http://www.huffingtonpost.com/carol-w-berman-md/capgras-syndrome_b_888854.html
    article by Jones & Bartlett Learning Medicine Author, Carol W. Berman, MD

    ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

    Did you ever look at your husband or wife and feel that person is an impostor? Janet, a 24-year-old graduate student, came home from a stressful day at school and found a man she thought was a stranger in her bed.

    "Who are you? How did you get into my apartment?" she asked.

    She was in no mood to fool around with a strange man who had somehow gained entrance to her apartment and was lounging on her bed in her husband's blue silk pajamas.

    "Very funny. And who are you?"

    The man countered. He looked similar to Dave, her husband. In fact, he had short brown hair, dark blue eyes and the same kind of round cheeks as Dave. However, Janet knew in her gut that it wasn't Dave. Maybe distant relatives or casual friends might believe the man was Dave, but Janet and Dave had been together practically every day for the last three years, and Janet could swear it wasn't her husband.

    As a psychiatrist I treat many bizarre conditions, but this case was one of the strangest. The movie "Invasion of the Body Snatchers," in which people correctly accuse their loved ones of being impostors, illustrates Capgras' syndrome. In the movie, the townspeople's loved ones were actually replaced by extraterrestrials who want to destroy humanity. In Capgras' syndrome, people falsely believe their loved ones are replaced by duplicates.

    Read More

    Topics: psychiatry, Capgras Syndrome, Carol W. Berman, Authors, Panic Disorder, psychiatrist, Pyschiatry & Mental Health, MD, NYU Medical Center

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