Musings – 08.08.21

What is PTSD?

“There is no timestamp on trauma. There isn’t a formula that you can insert yourself into to get from horror to healed. Be patient. Take up space. Let your journey be the balm.” 
David Serra.

One of the very first recognitions of Post-Traumatic Stress Disorder (PTSD) was in World War II when it was called Shell Shock. It really came into a greater understanding and identification in veterans of the Viet Nam War. As such, the Veterans Affairs Department has been at the forefront of diagnostic and treatment modalities of PTSD.

In reality, PTSD dates back to the earliest times, indeed, the time of early man, when just the living and staying alive was traumatic and difficult, and, certainly, questionable. In 1980 the American Psychiatric Association (APA) added it to the Diagnostic and Statistical Manual of Mental Disorder (DSM) III. In those “days” trauma was determined to be exposure to a catastrophic stressor, such as war. Ordinary stressors, such as divorce or serious illness.

Many accepted treatments for PTSD fall under the category of Cognitive Behavioral Therapy (CBT): Cognitive Processing Treatment (CPT). Prolonged Exposure Therapy (PET). Eye Movement Desensitization and Reprocessing (EMDR). Stress Inoculation Training (SIT). Acceptance and Commitment Therapy (ACT) is also becoming recognized as a viable and effective treatment modality for PTSD. As a licensed clinical social worker (LCSW) I am certified in EMDR, and am currently working on certification for ACT. As my primary practice occurs in telemedicine, i.e., online video sessions through HIPAA-approved confidential sites, I will not perform EMDR with a client, as PTSD can lead to dissociate states, and I feel that NOT being in person with my clients is extremely ill-advised. I do, however, feel that many people come to therapists with PTSD and deserve an effective treatment modality; indeed, they deserve hope and a view of the other side of PTSD, i.e., a life without PTSD.

Medication is also considered for PTSD, such as anti-depressants, such as a selective serotonin reuptake inhibitor (SSRIs), and a serotonin and norepinephrine reuptake inhibitor (SNRIs). At this time, the U.S. Food and Drug Administration (FDA) has only approved Paroxetine (Paxil) and Sertraline (Zoloft) for treatment for PTSD. Minipress (Prazosin) is also commonly prescribed for people who struggle with PTSD, as it can have a significant positive impact on sleep disturbances or nightmares, which is very common in PTSD. It is estimated that 40-60% of people treated for PTSD with these medications respond to them. 

A new view of the treatment of severe mental illness, including PTSD, has led to various studies looking at certain drugs and any possible positive symptomatology outcome. Included are methylenedioxymethamphetamine (MDMA), esketamine (Ketamine), classic psychedelics such as lysergic acid diethylamine (LSD), and cannabinoids (CBD and THC). THESE MEDICATIONS ARE ABSOLUTELY NOT CURRENTLY RECOMMENDED FOR USE UNLESS SUPERVISED BY A PSYCHIATRIST, HIGHLY SKILLED AND FAMILIAR IN ALTERNATIVE TREATMENTS FOR PTSD AND OTHER SEVERE MENTAL ILLNESSES. I am including this information for purely informative purposes, and to give people who have struggled with PTSD for years hope. Also, as many of my clients know, I keep myself highly informed about treatment options and find these medication studies fascinating and encouraging, and I further encourage each person who has any interest to talk to their psychiatrist about these medication possibilities. I feel that these medications and the related studies are certainly out of MY scope of practice, and, likely out of the scope of practice of a primary care physician.

Stay tuned for my next blog, where we start to explore ACT.

More Mental Health Musings coming next week!

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