Considering medications

[RadiantGazR]

Hello,

New here as of today. I have been struggling with what I thought was generalized anxiety but was really PTSD for the past 12 years. I started therapy via talkspace in 11/2019 and I’m on my third therapist, but first PTSD specialist. I feel chemically imbalanced honestly for the past 2 weeks and it’s worse around my menstrual cycle; can’t stop crying, blood pressure log is through the roof. I think it’s time to consider medication because I’ve tried exercise, meditation and tai chi daily, diet and therapy with temporary and don’t know what else to do. What is a good first time medication for PTSD? I’m probably going to ask my gp to start sertraline and a beta blocker such as propranolol. Would love to hear your thoughts. Thx

 

[Rainman8772]

Meds unfortunately are a wild ride. You have to find what works for you. Personally I take Effexor and buspar in the morning. Then buspar mid day. Then mirtazipine, prazosin, and buspar at night. Sometimes you get lucky and find what works quickly others do not. The Effexor and mirtazipine work together and have a synergy when taken together and work better then either one alone.

 

[Friday]

What is a good first time medication for PTSD? I

There isn’t one. Because there aren’t any medications specifically for PTSD. Instead, people tend to medicate the worst &/or most disruptive of their symptoms for long enough to do trauma therapy, to lower their overall symptoms / increase their ability to manage their stress & symptoms, then back off the temporary medication, do more trauma therapy, back off meds, more therapy. Round and round, until they’re off meds entirely & their PTSD is well managed.

(Ignoring the politics of labelling & off-label use for a minute)

Sleep meds for insomnia
Prazosin (Blood pressure med) for nightmares
Antianxiety for anxiety
Antidepressants for depression
Et cetera

Because PTSD can strike ANY baseline neurology (neurotypical or comorbid) there’s no sort of gold standard for which meds, in which classes, in which combos/cocktails, etc. It’s not like you’re looking at bipolar disorder where most people are on a cocktail of an antipsychotic for the manias, one or more antidepressants for the depression, and mood stabilizer to hold the combo in balance. People with PTSD are coming from wildly different sets of circumstances, with wildly different symptoms that cause them the most difficulty.

So it would be a question of looking at what symptoms are disrupting your life the most / making trauma therapy the most difficult... so that you can do the therapies and work on managing stress in your life, so you can then come off the temporary meds.

When people are on meds long-term “for” PTSD? It’s usually a comorbid disorder that’s being medicated (like MDD or GAD), or their therapist sucks & isn’t bothering to help them do the trauma processing necessary to treat & manage.

 

[RadiantGazR]

Meds unfortunately are a wild ride. You have to find what works for you. Personally I take Effexor and buspar in the morning. Then buspar mid day. Then mirtazipine, prazosin, and buspar at night. Sometimes you get lucky and find what works quickly others do not. The Effexor and mirtazipine work together and have a synergy when taken together and work better then either one alone.

Thank you for sharing. Another one of my concerns about starting medications is weight gain. How many of you have experienced weight gain? Is it right for me to think that my current fluctuations in weight are just worse because of my PTSD symptoms and cortisol etc? Because I read a study from Columbia University about significant difficulties losing weight while struggling with PTSD

 

[Rainman8772]

Thank you for sharing. Another one of my concerns about starting medications is weight gain. How many of you have experienced weight gain? Is it right for me to think that my current fluctuations in weight are just worse because of my PTSD symptoms and cortisol etc? Because I read a study from Columbia University about significant difficulties losing weight while struggling with PTSD

Personally I could care less about weight when I can function somewhat normally with meds and therapy. Most of these meds will make you gain weight so you have to stay active to keep it off. Don’t expect that last 10 pounds to come off you are wanting to. You have to look at your quality of life. The meds are not a cure all. Do they help when and if you find a combo that works for you, sure.

 

[Friday]

Is it right for me to think that my current fluctuations in weight are just worse because of my PTSD symptoms and cortisol etc?

No idea.

Stress affects metabolism. Whether that means a person gains weight under stress, or loses weight, will largely depend on their physiology.

Both eating disorders & disordered eating are both super common with PTSD... the second piece tied more strongly to behaviors secondary to symptoms (like not getting out of bed for months, or suffering from anhedonia with depression; or only eating when hungry -which doesn’t work, when anxiety has shut off the hunger response- or conversely comfort eating; or even highly trained chefs not being able to follow simple instruction / thrown by “simple” tasks, such as making a sandwich or pouring a bowl of cereal becomes an almost insurmountable), and some great big whopping et cetera as eating habits &/or finances are affected differently for different people depending on their symptoms. <<< In addition to full blown eating disorders, and disordered eating >>> One often finds people with PTSD who have trauma related food issues. Of which there are countless possibilities, but a few common ones are triggers and stressors related to rape & sexual assault (like the act of having something in your mouth, swallowing, feeling full, feeling internal pressure, etc.).

The medications people take for PTSD span the entire spectrum. Someone taking stimulants to manage the disorganized thinking & emotional dysreg, for example, may struggle to keep weight on no matter how much they eat, whilst another gains 30 pounds following eating regularly for the first time in years... meanwhile someone on a classic antidepressant may gain 200 pounds whilst being chronically malnourished / no matter their exercise level & starving themselves, or the get up and go go go following a few years of sedentary life may melt the weight off them as their metabolism is largely unaffected by the medication.

Shrug. So it’s a complicated series of factors, depending on your own unique physiology, environment, and lifestyle.

 

[Sideways]

Re your comment about things changing around your menstrual cycle? That's significant.

If you're on birth control? It might be time to try alternatives to what you're currently taking. If you're not, perhaps consider it? Speaking with a GP well-versed in women's health will pay dividends.

That's not me suggesting you're over-stating your symptoms, but rather, we too often overlook just how much birth control meds are usually impacting our mental health, and if that's a simpler, less side-effects option, it may be worth investigating.

 

[RadiantGazR]

Re your comment about things changing around your menstrual cycle? That's significant.

If you're on birth control? It might be time to try alternatives to what you're currently taking. If you're not, perhaps consider it? Speaking with a GP well-versed in women's health will pay dividends.

That's not me suggesting you're over-stating your symptoms, but rather, we too often overlook just how much birth control meds are usually impacting our mental health, and if that's a simpler, less side-effects option, it may be worth investigating.

Thanks for the advice. I actually am meeting with my GP next week to discuss changing contraceptives because I have high blood pressure