Many wonder whether medication is advised for PTSD and if so, what kinds are recommended. Read on to learn more about SSRI medications and treatment approaches for PTSD.

Medication for PTSD: Is It Advisable?

The current approach to treating PTSD involves both psychotherapy and medications. There are a number of medications that have been recommended and used to treat PTSD and associated symptoms, either in the early stages or later once it has become chronic and is more difficult to treat.

Of these SSRIs (serotonin reuptake inhibitors) have generally been the most effective. They are most commonly used as antidepressants and prolong the release of the neurotransmitter serotonin in the brain, bringing about a more positive mood, among other benefits.

A 2009 report summarized a wide range of studies and the current state of the art at that time. It said that SSRIs may produce clinically meaningful alleviation of suffering, but the size of the response left many patients with partial PTSD. The response rates of SSRIs rarely exceeded 60% and less than 20-30% of patients achieved remission [1]. Nonetheless, there are not yet any evidence-based alternatives equaling these results. And this has not changed.

SSRIs and PTSD

A 2009 study showed strong support for the SSRIs Paroxetine (Paxil), Sertraline (Zoloft)  and Fluoxetine as a first-line medication treatment for PTSD. They also have potential use for co-occurring conditions such as depression, other anxiety disorders and impulsivity.

Paroxetine and Sertraline have been approved by the FDA for PTSD and are effective on both a short (14 weeks) and a longer-term (1 year) basis. Yet they are still seen as falling short of being ideal due to limited response, remission rates and tolerability issues (the ability of a patient to tolerate the medication) [1]. Intervening with these medications soon after the trauma is critical for long-term outcomes, since with time traumatic memories become indelible and resistant to treatment [2].

The American Psychiatric Association guidelines for treating PTSD with SSRIs identify the following benefits [3]:

• They improve all three PTSD symptom clusters (re-experiencing, avoidance, hyperarousal)
• They are effective for co-occurring disorders that frequently occur with PTSD (depression, panic disorder, social phobia, obsessive-compulsive disorder)
• They may reduce symptoms such as suicidal, impulsive and aggressive behaviors) that often complicate management of PTSD
• They have relatively few side effects

How Do SSRIs Help With PTSD

SSRIs raise the level of serotonin which regulates mood, appetite and sleep. This helps to improve communication between nerve cells, leading to improved mood and decreased anxiety.

Studies in patients with PTSD show alterations in brain areas studied in animals, including the amygdala (the processing center for emotions), hippocampus (responsible for memory and learning) and prefrontal cortex (responsible for planning, prioritizing and making good decisions), as well as in neurochemical stress response systems, including Cortisol and norepinephrine. [2].

Antidepressant SSRI treatments have been shown to block the effects of stress and/or promote the growth of neurons (neurogenesis) in the hippocampus.

Currently, therapies such as CBT or its variants are shown to be more effective than medications. One theory of why is that PTSD—a learned fear response—can be particularly resistant to medication. PTSD patients show uncontrollable emotional and physical responses to reminders of the trauma. These involve an activation of the amygdala, the center of fear-driven learning.

One reason put forward for the limited effect of SSRI medication is that they affect the brain’s modulating systems such as serotonin, dopamine and others. However, these systems cannot effectively modify the type of learned responses found in PTSD. This is similar to the relative resistance of eating or addictive disorders to medications, when used alone [1].

Holistic Approach to PTSD Treatment

Complementary and alternative medicine (CAM) refers to techniques integrated with or substituting for traditional Western medicine practices. They are increasingly being used to treat PTSD. Techniques include [4]:

• Acupuncture
• Moxibustion
• Chinese herbal medicines
• Meditation
• Yoga
• Deep breathing exercises
• Progressive relaxation
• Tai Chi

These methods have certain strengths, requiring less talking and disclosure than psychotherapy and may not carry the risks of side effects from pharmaceutical approaches.

PTSD Treatment Options

In addition to SSRIs and some other medications, the American Psychological Association strongly recommends four therapies, all derived from Cognitive Behavioral Therapy (CBT) [5] :

• Cognitive Behavioral Therapy (CBT): Focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning
• Cognitive Processing Therapy (CPT): A type of CBT that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma
• Cognitive Therapy (CT):  Focuses on modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral or thought patterns that have been interfering in the person’s daily life
• Prolonged Exposure (PE): Teaches people to gradually approach trauma-related memories and situations. By facing what has been avoided, a person presumably learns that the trauma-related memories and cues are not dangerous and do not need to be avoided

The APA conditionally recommends these three therapies:

• Brief Eclectic Psychotherapy: Combines elements of cognitive behavioral therapy with a psychodynamic approach. It focuses on changing the emotions of shame and guilt and emphasizes the relationship between the patient and therapist.
• Eye Movement Desensitization and Reprocessing Therapy (EMDR): a structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements) which is associated with a reduction in the vividness and emotion associated with the trauma memories.
• Narrative Exposure Therapy: This approach helps individuals establish a coherent life narrative in which to contextualize traumatic experiences. It is known for use in group treatment for refugees.

PTSD Treatment in Utah

Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from trauma or PTSD, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.

Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.