Posted by PaulB on January 16, 2002, at 15:34:05
I have two serious concerns regarding the use of Zoloft for PTSD.
Firstly, and let me take an example. A women is raped and goes to a rape centre. A gynecologist or psychiatrist diagnoses her as having PTSD and prescribed Zoloft and refused a benzodiazepine because of some of the concerns psychiatrists have about their use in PTSD.
Dr-Bobs section at the home page on treating PTSD indicates some of the concerns one particular medic raises in regards to benzodiazepines and PTSD.
""My observation has been that many combat vets on Xanax have periods of anxiety and irritability during each day that do them great harm, and which, in my view are mostly mini-withdrawal reactions between doses.
Possible dangerous peculiarities of Xanax in PTSD during withdrawal: The staff of the in-patient PTSD unit at the American Lake VA in Washington State have published a paper reporting extreme violence by combat vets treated for long periods with Xanax and then taken off of it. This was apparently more frequent and more severe than what they found taking their patients off of other benzos, such as Valium. Several Vietnam combat veteran peer counselors whom I respect very highly, feel that Xanax has done a lot of harm. Xanax has some unique properties among its cousins in the benzodiazepine family. In lab tests Xanax acts the opposite at low blood levels of how it acts in the larger amounts actually used in medical practice. When you think about it, everybody passes through a low blood level twice when they take a pill -- once when the pill is just being absorbed in the body and once when the body is almost done getting rid of it (unless, of course, the person takes the same pill again, before the first one is completely gone). Whether this is what causes the problems with Xanax is not clear right now.. She then has to wait 2-4 weeks for the AD to 'kick-in'. Im sorry but I dont hink that's acceptable[yeah, my point exactly] The women would be in need of immediate ......."
This guy raises the same first concern of mine and also indicates that benzodiazepines are not appropriate.
My second concern regarding Zoloft being prescribed for PTSD is that Zoloft will work by elevating CNS 5-HT[serotonin] levels. 5-HT especially during initial prescribing will be at its highest levels. 5-HT increases dream activity. This may cause nightmares of the incident that caused the PTSD. I know because Ive been there. I had panic attacks and was prescribed Zoloft and had nightmares about the panic attacks. I have always dreamt more when been prescribed a seroternergic antidepressant.
To conclude, what can be done. The best I can come up with is intensive psychotherapy 2-3 times a day and careful monitoring of a suitable benzodiazepine by the pysychiatrist. What would be the most suitable benzodiazepine. I think due to the horror of the experience that causes a PTSD in my country the NHS(National Health Service) should make it available, unfotunately the NHS is in debt and the number of people who experience a PTSD must be very high. Alternatively the person could be admitted to the hospital psychiatric unit and carefully observed on a benzodiazepine. Dont forget the benzodiazepines are all different, they really are, and I would like feedback on which would be most appropriate and why.
PaulB
poster:PaulB
thread:90504
URL: http://www.dr-bob.org/babble/20020116/msgs/90504.html