Post- Traumatic Stress disorder (PTSD) Treatment

 

 

 

 

What is Post- Traumatic Stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an event where a person is exposed to actual or threatened death, serious injury, traumatic childbirth or sexual violence.

PTSD affects about 4% of adults in Australia and New Zealand. It is diagnosed more in women than in men.

What is complex Post- Traumatic Stress disorder (PTSD)?

Some individuals with PTSD also have another cluster of symptoms such as affective dysregulation (e.g., emotional reactivity), negative self-concept (e.g., low self-worth) and interpersonal problems (e.g., fear and avoidance of relationships. These additional symptoms have typically been captured by making additional diagnoses of Borderline Personality Disorder, Dysthymia or Major Depressive Disorder and Social Phobia respectively. However, Complex PTSD may warrant a place for itself in our diagnostic and treatment protocols. To illustrate this, we will first deconstruct Complex PTSD.

Reference: C.R. Brewin et al. Clinical Psychology Review 58 (2017) 1–15

It is worth noting that PTSD is defined by symptoms of re-experiencing, avoidance and sense of threat, which cluster together whereas complex PTSD has another dimension added to it which can be factored in as disturbances in self-organisation. One might wonder whether this dimension can be seen as underlying borderline personality(BPD). However, studies have found limited evidence of overlap.

What causes Complex PTSD?

There are subtle differences to what causes PTSD vs Complex PTSD. Compared to PTSD, those who develop complex PTSD has more of:

  • Genetic vulnerability
  • Reduced personal resilience
  • Female gender
  • Unsupportive or invalidating family
  • Increased comorbidity
  • Increased chance of being unmarried, unemployed

With regards to the type of trauma exposure, complex PTSD develops after:

  • Childhood interpersonal trauma
  • Severe trauma
  • sustained trauma
  • Multiple trauma, the severity and complexity of PTSD increases after every new event (dose-response relationship)

Getting help with PTSD

PTSD is treated by psychiatrists, psychologists and general practitioners. Sometimes you may need all of them at once or you may need one or the other. If you are looking for getting help for PTSD in Melbourne, consult your family doctor to get a referral to a psychologist. Your GP may also refer you to other support services or may discuss mandatory reporting if that applies. They may also initiate anti-anxiety treatment using pills.

Who is the specialist for PTSD?

Psychiatrists can help you with an accurate diagnosis, help you minimise your symptoms using medications and formulate a psychological treatment plan to enhance your recovery. They often work in close liaison with your psychologist, GP and support worker to optimise your recovery.

Psychiatrists are medical specialists with a post-graduate medical degree in mental health and are often your next layer of care when your initial treatment plan is inadequate. An individually tailored plan is often required at this stage to remove barriers to you getting well. They may also organise hospitalisation if required. In a nutshell, a psychiatrist is the doctor for PTSD who can prescribe medications and monitor them. Psychiatrists as specialists for PTSD often use medications which are not usually available through your family doctor.

What are the available Treatment of PTSD?

Treatment options for PTSD belong to 2 major classes psychological and pharmacological (medicines). Most effective treatments for PTSD are those which given consistent, reliable results and are readily available.

Psychological Treatments for PTSD

Cognitive behaviour therapy (exposure) is recommended as the first line treatment in PTSD and has a high strength of evidence supporting its efficacy.  CBT is otherwise called talk therapy or counselling. However, this intervention is powerful enough to give you great results. It has a cognitive(thinking) component aimed at changing dysfunctional negative thoughts and a behavioural component(exposure). There is evidence to suggest that CBT can enhance and correct some of the problems in your neuronal circuitry, thus giving you long term benefits.  The neuropsychology behind this is explained under disorders/PTSD, on this website. Other commonly available psychology treatments such as Eye movement desensitization and reprocessing (EMDR) and Cognitive processing therapy which are moderately effective.

Pharmacological management of PTSD

Traditionally, medicines for PTSD were known to alleviate symptoms of PTSD to a mild to moderate degree. Newer studies have shown that Both CBT and anti-depressants can produce changes in neuroplasticity (e.g. changes in neurite growth, dendritic spine density, synapse number, intrinsic excitability, etc.) but these neuroplasticity changes are usually brought about by long term treatment.For instance SSRI’s have an excitatory effect on hippocampus but an inhibitory effect on lateral orbitofrontal cortex, amygdala, thalamus and cingulate cortex. Unlike anti-depressants, newer agents like ketamine, psychedelics and N-methyl-D-aspartate (NMDA) receptor partial agonists can reshape circuitries and connectivity even within a day. However, such drastic changes may also come with safety issues which is yet to be researched. To summarise, treatment effects in PTSD are associated with Increased activation of cognitive control networks, reduced Amygdalar activation and increased connectivity between the cortical centres and the limbic cortex. Associated effects such as REM sleep suppression and regulation of autonomic responses may also be vital.

Ref: S.B. Sartori, N. Singewald / Pharmacology & Therapeutics 204 (2019)

A recent network meta-analysis has compared the current medicines used in the treatment of PTSD (medicine for post-traumatic stress disorder). Such studies are done when direct comparisons between commonly used medications are not available. Their statistical comparisons yielded the following results which are arranged in the order of their efficacy and side effect profile below.

Anti-depressants

  1. Phenelzine
  2. Desipramine
  3. Paroxetine
  4. Venlafaxine
  5. Fluoxetine
  6. Sertraline

Mood stabilisers

  1. Lamotrigine
  2. Topiramate
  3. Vigabatrin

It is worth noting that Citalopram and Valproate were generally inferior to the above treatments. Prazosin which is usually given to suppress nightmares, appeared to have minimal efficacy and high dropout rates in this study.

Reference: Cipriani A, Williams T, Nikolakopoulou A, Salanti G, Chaimani A, Ipser J, Cowen PJ, Geddes JR, Stein DJ (2018). Comparative efficacy and acceptability of pharmacological treatments for posttraumatic stress disorder in adults: a network meta-analysis. Psychological Medicine 48, 1975–1984.

PTSD treatment Melbourne

Psychiatry team at Mindoc, Melbourne can offer you expert advice and support on resistant PTSD symptoms. We have tailored medical treatment plans for PTSD and comprehensive mind body programs which may offer you quick recovery. The treatment plan for PTSD usually begins with formulating a psychological management plan which may be assisted with medications.  If you are looking for PTSD treatment near you, consider giving us a call to discuss or book online to get an appointment with our psychiatrists.