THE PAINFUL TRUTH OF PTSD

 6 months ago

written by Pat Rabjohn, MD


During the holiday season, sufferers of PTSD tend to have a more difficult time dealing with their symptoms. There are a number of issues that surface around this time of year, such as feeling like an outsider in a gathering of family and friends, having an overwhelming a sense of guilt or irritability, and a general hypersensitivity to interactions with the world around them. The diagnosis and management of Post Traumatic Stress Disorder (PTSD) should be performed by a Psychiatrist who is board-certified by the American Board of Psychiatry and Neurology. PTSD is a complex diagnosis that often presents with signs and symptoms of psychosis, clinical depression, and severe anxiety.  Whether you are completing a military deployment, a firefighter, police officer, EMS worker, physician, athlete, school-teacher, a loving mother, or suffered from events such as the Dallas Police shootings, PTSD can find you.

When To Know It’s PTSD

The diagnosis of PTSD requires five criteria to be met.  While the criteria in the DSM-V have been modified, the core remain intact.

  • There has to have been a significant trauma; this can be a near-death experience, sexual assault, a car accident – some form of trauma that involved the threat of death or severe injury.  Also, the response has to include intense fear, helplessness, or horror.
  • You must be re-experiencing in the form of flashbacks or nightmares. These painful recollections must produce some reactivation – putting you back in that fear or helplessness state.
  • The trauma must create some form of avoidance; you will go out of your the way to avoid people or places or thoughts associated with the prior traumatic event.
  • You will display some form of hypervigilance, typically with irritability towards other or anger outbursts.
  • The combination of these symptoms must result in a significant change in behavior that leads to impaired social functioning, negatively impacting the patient’s job and meaningful relationships.
  • People who develop PTSD also have a high rate of psychiatric comorbidity.  Unfortunately, substance abuse and dependence rates are high once PTSD symptoms develop.  Obviously, these patients are prone to high rates of major depression and panic disorder as well.

How Is PTSD Treated?

The treatment of PTSD is complicated and continues to evolve.  Large population, properly designed clinical trials are lacking.  Our best evidence points to the use of high-dose Selective Serotonin Reuptake medications to limit anxiety and depressive symptoms.  There may need to be off-label augmentation with L-methylfolate, Aripiprazole, or lithium to achieve a response or remission in symptoms.  While prazosin has shown mild promise to limit nightmares, other medications (atypical antipsychotics like quetiapine and risperidone) have not been as efficacious as hypothesized.  No sleep benefits have shown when Zolpidem (Ambien) and benzodiazepines like Clonazepam or Alprazolam are used in the PTSD population.  Even with proper medication choices and proper dosing, patients may need to stay on medications for a substantial length of time, which can bring side-effects into play.

In addition to medications, psychotherapy is becoming an increasingly valuable tool to remove symptoms associated with traumatic events.  Specifically, Eye Movement Desensitization Reprocessing or EMDR is an empirically validated therapy that targets unprocessed memories connected to adverse experiences, like war, sexual abuse, and physical abuse.  By processing these traumatic memories, there can be rapid symptom relief:  fewer flashbacks, fewer panic attacks, and less obsessive thoughts.

EMDR reprocessing typically involves a series of repetitive eye movements that is a simulation of the rapid eye movement that occurs during REM sleep.  This reprocessing happens through the eye movements, which are guided by the EMDR therapist.  The eye movements allow the brain to free associate to related memories, thus linking the past and present.  By using these eye movements, we think processing of past trauma is initiated by the idea of dual attention or focusing on the eye movements while focusing on the memory, or through encouraging the brain to access both the left and right hemisphere causing the memory to be processed from a highly charged emotional memory to a more adaptive form.  However, the reality is we aren’t 100% sure why or how this therapy works, but with over 30 extensive clinical trials, we know it is very effective when performed by a trained and experienced therapist with a patient who desires to improve the quality of their life.

If you or a loved one are suffering from past trauma, don’t hesitate any longer.  Good, quality help is available.  Here at Rabjohn Behavioral Institute, we have two board-certified psychiatrists, Dr. Pat Rabjohn and Dr. Sandra Davis who can make an accurate diagnosis and prescribe appropriate and safe medication.  Also, Ms. Tiffany Mylett works alongside these experienced clinicians as a certified EMDR psychotherapist.  Help is available; you just need to ask.

Dr. Patrick Rabjohn is a Dallas Fort Worth and Mansfield, Texas Psychiatrist. Dr. Rabjohn is Board Certified by the American Board of Psychiatry & Neurology and Medical Director of Rabjohn Behavioral Institute treating psychiatric conditions including depression, anxiety disorders, adult ADD and more. Dr. Rabjohn has been named 2014, 2015, 2016 Top10MD an honor only 1 in 3 Doctors in the United States succeed with this recognition in the United States. To schedule an appointment contact Dr. Rabjohn for medication management or Ms. Tiffany Mylett for EMDR at 817-539-2282.

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