panic stress disorder

panic stress disorder

Pharmacotherapy of the fight against stress, PTSD

Winter 2007 ANNALES www.americanpsychotherapy.com

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For Harpriya A. (Sonia) Bhaga, MBBS and Alan D. Schmetzer, MD, member of the American Association of Psychotherapy, Therapist and Teacher

A number of veterans of Operation Iraqi Freedom / Operation Enduring Freedom (OIF / OEF) are returning home with signs to fight against stress-related posttraumatic stress disorder (PTSD). In a recent study, 16.6% of soldiers who met the selection criteria for PTSD. On average, showed a significant increase in visits from patients, workdays lost, severity of somatic symptoms, and generally poor health (Hoge et al., 2007). In another study, the youngest age group 18-24 years had higher risk compared with veterans 40 years or more. The diagnosis is made early (median 13 days), and most of them have been detected in primary care clinics (Seal et al., 2007).

Back from the war zone, veterans often report intrusive thoughts, flashbacks, increased vigilance, prevention of social situations, hypervigilance, and nightmares. The treatment involves the integration of mental health, primary care, physical medicine, attention to substance abuse services and training. The portion of the mental health consists of an initial review of war veterans for PTSD and other mental illnesses, followed by a full evaluation. Both pharmacotherapy and psychotherapy (individual, couple and group) are available for processing.

From pharmacological point of view, several Studies have found traditional anti-depressant effective in PTSD. Inhibitors selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft ®) Paroxetine (Paxil ®) and fluoxetine (Prozac ®), have been widely studied for PTSD, and sertraline and paroxetine were approved by the Food and Drug Administration for PTSD. SSRIs have been proven effective, both short-term trials and long-term maintenance treatment Prevention of relapse (Asnis et al., 2004). However, past studies have focused on the syndrome of PTSD secondary to trauma interpersonal skills in a civilian environment. In a multicenter, extended release venlafaxine (Effexor XR ®), an inhibitor of the reuptake of serotonin, norepinephrine, was found to improve both the re-experiencing symptoms and prevent PTSD, but not hyperstimulation. The drug was effective and well tolerated in both short term and continuation treatment of PTSD (Davidson et al., 2006). In a small study, mirtazapine (Remeron) has been found be effective for both short term and continuation treatment of combat stress-related PTSD, without serious side effects (Kim et al., 2005). In addition, sedation, mirtazapine may even prove beneficial in improving sleep in PTSD. In a randomized trial comparing phenelzine (an inhibitor of monoamine oxidase) and imipramine (tricyclic antidepressant), both to fight against stress significantly reduced the symptoms associated with PTSD (Kosten et al., 1991). Benzodiazepines are used in PTSD for panic attacks or anxiety states. They provide temporary relief, but run the risk of tolerance and dependence.

Veterans suffering from PTSD is difficult both to sleep and maintain because of nightmares and also live to fight sleep-related hyperarousal. Relatives often report that patients cry in sleep and may wake up drenched in sweat. Prasozin and clonidine both reduce the activity of noradrenergic central nervous system. They have proved effective in reducing symptoms overdrive and improving sleep (Boehnlein, 2007). Other medications used for sleep are the class of drugs such as benzodiazepines temazepam, not benzodiazepines as zolpidem (Ambien ™) and ezopiclone (Lunesta ™). However, precautions must be taken in about the potential of this drug habit (Bhaga and Schmetzer, 2006).

The presence of psychotic symptoms in PTSD May complicate the clinical picture. In one study, 20% of the 91 men with combat stress, PTSD was found suffering from hallucinations and delusions, and excitement was positively associated with the onset of psychotic symptoms (Kastela, 2007). In a small study, the increase of SSRIs with olanzapine (Zyprexa), an atypical antipsychotic, has been effective in treating SSRI-resistant combat symptoms associated with disorders of PTSD in especially sleep (Stein, 2002). In another study, monotherapy with typical or atypical antipsychotic, reduced both PTSD and psychotic symptoms, and antipsychotics seemed to offer another way to treat subtype anti-psychotic PTSD related resistant to therapy with antidepressants previous (Pivac, 2006).

In general, PTSD Pharmacotherapy includes several drugs based on our experience of post-traumatic stress in general, but well-designed studies are needed to establish treatment guidelines specific to fight against stress-related PTSD.

References

Asnis GM, Kohn SR, Henderson, M., & Brown, NL (2004). SSRIs versus non-SSRIs in posttraumatic stress disorder: an update of recommendations. Drugs, 64 (4), 383-404.

Bhaga, HA, and Schmetzer, AD (2006). The new sleep medications. Annals of the American Psychotherapy Association, 9 (2) 25-26.

Boehnlein, JK, & Kinzie, JD (2007). Reduction of the pharmacological activity of the CNS noradrenergic in PTSD: the case of clonidine and prazosin. Journal of Psychiatric Practice, 13 (2), 72-78.

Davidson, J. D. Baldwin, Stein DJ, Kuper E, Benattia, I. Ahmed, S., et al. (2006). Treatment Syndrome Posttraumatic Stress Disorder with venlafaxine extended release: 6-month randomized controlled trial. Archives of General Psychiatry, 63 (10), 1158-1165.

Hoge, CW, Terhakopian, A., Castro CA, Messer SC, & Engel, CC (2007). Association of Posttraumatic Stress Disorder with somatic symptoms, the views health care and absenteeism among veterans of the war in Iraq. American Journal of Psychiatry, 164 (1), 150-153.

Kastela, A. Franciskovi,? T., Moro, L., Roncevic-Grzeta, I., Grkovic, J., Jurca, V., et al. (2007). Psychotic symptoms in combat related to PTSD. Military Medicine, 172 (3), 273-277.

Kim W, Pae CU, Chae JH, Jun, TY, & Bahk, WM (2005). The efficacy of mirtazapine in the treatment of the disorder PTSD: A 24-weeks therapy followed. Psychiatry and Clinical Neurosciences, 59 (6), 743-747.

Kosten TR, Frank JB, Dan E, McDougle, CJ, & Giller, EL, Jr. (1991). Pharmacotherapy for the disorder PTSD using phenelzine or imipramine. Journal of Nervous and Mental Disease, 179 (6), 366-370.

Martenyi, F. (2005). [Three paradigms in the treatment of Post Traumatic Stress Disorder]. Neuropsychopharmacol Hung, 7 (1), 11-21.

Pivac, N. and Kozari?-Kovacs? D. (2006). Pharmacotherapy of treatment-resistant combat-related PTSD with psychotic features. Croatian Medical Journal, 47 (3) 440-451.

Seal KH, Bertenthal D, Miner CR, Sen, S., & Marmar, C. (2007). Zoom the war at home: the mental health disorders among 103,788 U.S. veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167 (5), 476-482.

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I was recently diagnosed with panic disorder, anxiety and possible Post Traumatic Stress Disorder.?

I so many things that I do not know where to start. My family and I are losing our home to foreclosure is one thing. Im going through a major crisis in time and I do not know what to do. Should I go to the hospital?

Try to calm down and breathe deeply and slow down or stop if not then yes defintly go to the doctor