When I worked at the VA treating young men coming back from Vietnam, we didn’t have a diagnosis nor a treatment for what we now call PTSD. During the intervening years, we’ve learned a lot. I will cover more in the following blogs, but this one is a synopsis.
We know that most PTSD symptoms are caused by:
1) An overactive sympathetic nervous system sending toxic stress chemicals to our brain.
2) Traumatic memories, which are stored—thanks to the stress chemicals—in a way that makes them difficult to access and treat but allows them to surface suddenly when triggered.
This knowledge has helped us to come up with new treatments that actually work for most people.
WHERE DO YOU START?
First off, you need a diagnosis. In short, you need:
1) A history of trauma that occurred at least a month ago. (If it’s more recent, you may have Acute Stress Disorder)
2) Symptoms of arousal like trouble with sleeping, irritability, aggression, self-destructive behaviors, or easy startling, that started after the trauma.
3) Problems with intrusive memories, flashbacks, nightmares, or panic attacks.
4) A pattern since the trauma of avoiding things, places, and people that remind you of what happened.
5) A negative change in how you see the world, yourself, other people, or an inability to engage in work and/or previously enjoyed activities.
6) No other mental or physical illness that could better explain all your problems.
IF YOU HAVE PTSD, WHAT DO YOU DO NEXT?
STEP ONE: Calm down your sympathetic nervous system and rebalance your brain chemistry.
1) The fastest way to treat hyper-arousal symptoms is to take a medicine that blocks the effects of norepinephrine (noradrenalin) in the brain. To accomplish this, many doctors use Prazosin, a blood pressure pill that gets into your brain and calms you down. For 75% of people, this allows them to sleep and reduces other hyper-arousal symptoms. Trazodone, cannabinoids, and other medicines can also help, but all medications can have some side effects.
2) Now you need to rebalance the chemistry inside your brain, which was upset by all the stress chemicals. Antidepressants like Paxil and Zoloft are commonly used, but they can increase nightmares, cause sexual side effects, and don’t work for everybody. Remeron, Effexor, or Pristiq may work better. If you can’t take any of those, try SAMe, which is available over-the-counter. Cannabinoids like THC and CBD actually do help rebalance the natural cannabinoid pathways in the brain, but they also cause short-term memory loss and other side effects in some people.
There are some new medical approaches that don’t require pills. They are considered experimental for PTSD but have been used successfully to treat other disorders. The best tested are:
1) The Stellate Ganglion Block is a nerve block in your neck, which blocks the sympathetic nervous system and its effects inside your brain. Studies have shown this to be effective in 75% of PTSD clients who did not respond to medication and exposure therapy.
2) Magnetic stimulation of your brain changes the electrical impulses in your brain allowing it to reset and reorganize. It’s been used for depression and autism, and it seems to help with flashbacks in PTSD.
STEP TWO: Exposure Therapy
By now you should be able to sleep most nights and have better control of your emotions—except when you get triggered. It’s very important to take this second step because the triggers reactivate your sympathetic nervous system making it hard to stay calm.
1) Telling your story is the simplest and cheapest approach. Just talk about what happened to somebody you trust. You need to go into all the details, because those can become triggers. And you need to get feedback from your listener as he or she may have a more objective viewpoint on what happened. Repetition and detail are essential for this approach to work.
2) Eye Movement Desensitization and Restructuring (EMDR) works even if you can’t talk about what happened. Here you need a trained therapist, but once you learn the technique it’s very portable and you can use it yourself if you get triggered.
3) Cognitive Behavioral Therapy is helpful if you’re stuck in a negative mindset with regards to yourself, other people, or the world in general. This requires a trained therapist who will help you look into your negative beliefs, discuss their roots in your trauma, and help you reevaluate your new place in the world.
4) Some medications help with therapy. Talk with your therapist about using propranolol, D-cycloserine, or Marijuana- where it’s legal.
STEP THREE: Need more help? Try one of these Alternative Therapies:
1) Meditation and Mindfulness have been proven to reduce PTSD symptoms, improve focus and concentration, and help you get control over runaway emotions. It does require you to practice on a daily basis.
2) Exercise, animal therapy, service animals, art, writing, comedy, acting, and getting involved in helping other people. All have been shown to reduce PTSD symptoms and make it possible to get out in public and start figuring out who you are now and what you really want to do with your new life.
People who’ve had PTSD symptoms are more prone to suffer it again, either from new trauma or discovering an old trigger that’s been overlooked. Treat a recurrence quickly so you prevent the sympathetic nervous system from going on a rampage and damaging your brain. If you go without sleep for several days after a trauma, consider taking a pill that blocks norephinephrine, like Propranolol or Prazosin. They can help prevent PTSD, as can MJ. You can also use whatever has worked for you before. It’s easier to treat PTSD once you know what to do and have the tools.
Don’t expect your life to go back the way it was. Trauma changes you, permanently. You’ll never look at yourself, or other people, the same way because you’ll never again be that naïve. But you’ve learned a lot which can be helpful, both to you and other people. Try sharing your experience and knowledge or using it in a unique creative way.
Don’t sell yourself short! Treatment helps most people, and if it doesn’t work for you, keep trying new approaches until you find one that does. I’ll be publishing more blogs that describe PTSD treatments in more detail.