Medications

Typical first line treatment is with selective serotonin reuptake inhibitors (SSRI's) such as Prozac, Paxil, Zoloft or Lescol. Trazadone and nefazadone (Serzone) are being re-studied since the have SSRI properties and they also reduce or suppress REM sleep, thus reducing or eliminating nightmares. Tricyclic antidepressants and MAOI's have been tried but there is no proven efficacy for these types of medications.

Benzodiazepines were once the first line of treatment but the efficacy has not been proven in controlled studies. They can also cause dependency problems for people who must deal with substance abuse issues. These types of medications also come with a variety of discontinuation problems.

Psychotherapy

Once medications relieve the most distressing symptoms a patient can then concentrate on psychotherapy. A key element to success here is beginning the initial medication treatment within two weeks of the trauma. Then the goal of therapy, breaking the pattern of self-defeat by reexamining the traumatic event and the patient responses to it, can begin. Education about the disease and recognition of cues or situations that trigger symptoms are invaluable. Complete education and healing consists of:

* Exposure

Exposure to the event via imagery allows you to reexperience the event in a safe, controlled environment where your reactions can be monitored.

* Examining

Examining feelings such as anger, shame, guilt, etc. allows you to work on resolving these feelings.

* New Coping Skills

New coping skills teach you how to handle reminders, reactions and feelings without becoming overwhelmed or emotionally numb. This can help foster your relationships with others. Some of the techniques used are:

* Relaxation (i.e. breathing techniques, visualization)

* Biofeedback

* Cgnitive restructuring

* Managing Anger

* Preparing for stress reactions

* Addressing urges to use alcohol or drugs

* Communications and relating effectively with people

Group treatment has also proven to be quite helpful for PTSD sufferers. This type of setting allows you to share with others who are more empathetic to your feelings. Being able to share instills more confidence and helps you to trust again. After being allowed to share your trauma you are freer to engage proactively in current relationships.

Eye Movement Desensitization and Reprocessing (EMDR)

This is a relatively new treatment that combines elements of exposure therapy, cognitive behavior therapy and then uses techniques (eye movements, hand taps, sounds, etc.), which creates an alteration of attention back and forth across the person's midline. Fourteen controlled studies have been done on EMDR. The last five done on trauma patients (abuse, rape, accident victims, etc.) have found that 84-90% of the individuals suffered no PTSD after only three sessions. In a study for combat veterans, 77% showed no PTSD symptoms after twelve sessions. Like all therapy the progress rate depends on the individual and the type of trauma. To administer EMDR, therapists must undergo special training.

Although PTSD manifests itself in a wide variety of symptoms there is a common factor. If you have lived through any type of experience that has caused you to feel threatened by death (either real or perceived) or threatened serious physical injury to yourself or to others, and you felt intense fear, horror or helplessness, you could be suffering from PTSD and may not even be aware of it. If you have experienced a traumatic event, lived an abused life, or cannot deal with something that you were confronted with, please seek the help of a professional. No one should have to live a life in constant fear or helplessness.

By Terry Coyier

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