Zoloft, Depakote and Seroquel in the Treatment of PTSD

Posttraumatic stress disorder can affect anyone who has experienced a harrowing event. Natural disasters, wars, and traumatic life experiences—physical or sexual abuse and accidents—can result in emotional, cognitive, and behavioral dysfunction.

PREVALENCE OF PTSD

• Lifetime prevalence in the general adult population = 7.8%
• Women (10.4%) are twice as likely as men (5%) to have PTSD
• About 30% of Vietnam War veterans; 10% Gulf War veterans; 11% of Afghanistan war veterans; and 15-20% of Iraq War veterans have PTSD.

DIAGNOSIS OF PTSD

The diagnosis of PTSD is made when alarming, distressing, and painful experiences produce the following symptoms:

• Nightmares, intrusive thoughts, or flashbacks regarding the event
• An attempt to avoid situations that produce memories of the event
• A constant state of vigilance, watchfulness, or startle reactions
• Emotional numbness, social isolation, or detachment from events and activities.

COEXISTING ILLNESSES

• PTSD can increase the potential for panic disorder, OCD, phobias, generalized anxiety disorders, depression, and substance abuse.
• Likewise, personality disorders, substance abuse, and other primary psychiatric illnesses can increase susceptibility to PTSD.

BRAIN DYSFUNCTION SECONDARY TO TRAUMATIC STRESS

• The hyperactivation of the amygdala increases emotional distress.
• Hyperactivation of the hippocampus increases the memory of the event.
• An increase of norepinephrine in the locus coeruleus causes hypervigilance and engenders startle reactions.
• An excessive release of the excitatory neurotransmitter, glutamate, increases irritability and anxiety.
• A decrease of the calming neurotransmitter, GABA, reduces CNS inhibition.
• A deficiency of serotonin increases suicidal impulses and aggressiveness.

TREATMENT

• Selective serotonin reuptake inhibitors (SSRIs) often produce positive results.
• Because of dosing flexibility and low side effect profile, Zoloft (sertraline) in doses ranging from 50-200 mg may be the medication of choice.
• Benzodiazepines, because of the abuse potential and lack of efficacy, are contraindicated in PTSD
• Antipsychotics (e.g. Seroquel) may be necessary in patients with severe PTSD symptoms. These medications are especially helpful for flashbacks and traumatic dreams.
• Mood stabilizers (e.g. Depakote) are helpful for irritability and angry outbursts associated with PTSD
• Cognitive behavior therapy may help relieve secondary symptoms—anger, social withdrawal, bitterness, or resentment—but often fails to alleviate primary symptoms such as startle reactions, nightmares, and flashbacks.