Newly Diagnosed- Med Questions

[Haileesmom]

Just introduced myself in the intro forum as I'm new here. I've just been giving the complex PTSD diagnosis for the second time in my life. I really like my therapist so far. She plans on using CPT. She's a LPC so she can't make medication recommendations but my family dr is the same one I've had all my life. He recently put me on klonopin 0.5 mg twice a day to deal with a recent anxiety issue with my marriage and to help with my early marriage counseling but he has no idea about the PTSD yet. I haven't told him in all these years. My therapist thinks I would benefit from a daily controlled medication in addition to the klonopin. My brother (who has combat PTSD/TBI) said I need to also be on an SSRI. I was on Zoloft, Paxil and lexipro at different times as a teen for "depression" and I hated them. They made me feel like a zombie. What my therapist DID tell me is she doesn't want me on something that will make me emotionally numb or "unavailable" because she needs me "present" to work through processing the memories. I don't know where to start on what to ask my dr for.

Does anyone have any info on ones that have worked well for you other than the Paxil, Zoloft or lexipro?

 

[Justmehere]

If you can, I would suggest consulting with psychiatrist to figure out a good medication regimen, and then have your primary care doc do follow ups. PTSD is complicated, and there are a lot of medications out there that can be used for PTSD including SSRIs, mood stabilizers, atypical antipsychotics (one of them did wonders for my anxiety) and others. Most of those mediations are best figured out by a psychiatrist with some experience treating PTSD. Primary care doc's can be great doc to follow a patient, especially when the patient and doc have a good working relationship, but they don't have the level of training and experience needed to really figure out the best medication fit for PTSD.

Klonopin and other benzodiazpines should only be used with a lot of care and caution. They typically lose effectiveness overtime and they come with some significant long term drawbacks and side effects (like increasing rates of dementia later in life.) I have been on several different ones, including Klonopin. They have their place, but it's good to be very careful and conservative with them. These medications can actually help or interfere with trauma processing - so I would talk to the doc about possibly using them on an as needed basis instead of every day, once you find other options to manage symptoms. This would help prevent your body from adjusting to them, and would help keep them effective for longer use.

 

[Haileesmom]

Thank you justmehere, that's good info. The klonopin was only to deal with a short term thing that was preventing me from being able to eat or sleep at all (husband cheated essentially). My brother also recommended a psychiatrist for medicine assistance but I'm concerned whether my insurance will cover going to them as well as therapist. And I really don't want to have to go through processing all this with two people. With the psychiatrist, do you just provide basic info like the PTSD diagnosis and symptoms and that's all you have to talk about other than meds? I'm so new to all of this and confused.

 

[Friday]

What works well for any of us doesn't matter... Our neurochemistry is all different.

Similarly... If you had a serious heart condition, would you go to your family doc or a cardiologist? Cardiologist. The brain is even more important (and far more complicated!) than the heart. Go to a psychiatrist. (Medical doctors, who then specialize going through several more years of study in neurology & psychology, same way a surgeon goes on to specialize). Most of the psychiatrists I know spend 40-60 hours a week keeping caught up on their reading alone (studies, peer review studies, medication alerts -off label use, recalls, new side effects listed, treatment modalities, warnings, etc.). A GP simply doesn't have the time to do that. Not for psychiatry, neurology, dermatology, cardiology, etc. That's mostly why docs specialize these days. Used to be a GP could stay caught up on everything. Now, their most valuable skill is being able to recognize when a specialist is needed / identifying what area needs needs what specialist (damn sight harder than it sounds: jack of all trades, master of none).

It can be just as much of a pain to find a good psychiatrist as it is to find a good psychologist or GP. But it's 100% worth it.

Most psychiatrists don't do counseling. LOL that 40-60 hours a week of staying caught up in their field! They do 15 min (avg) medication management sessions (every 1-3 months once you've found a good combo, once a week or two when you're still seeing how certain meds respond with you -seriously, our neurochemistry makes this challenging). They need to know about your symptoms... Not what caused those symptoms. Many are also more than willing to team care with your psychologist... So they confer based on what you tell your therapist, and you just need to basically confirm those notes, and add anything missed or misspoken. It's a pretty impersonal arrangement in my experience.

 

[Justmehere]

That's terrible what your husband did and your reaction seems normal for what you have been through. Klonopin alone makes sense for one-time stressors. PTSD is an anxiety based disorder, so some of the anxiety you feel related to the marriage problems is intertwined with the PTSD. There are lots of medications for sleep and ect that might help more than the Klonopin over the long haul as you work on healing from what you have been through in therapy. For example, I take Trazadone for sleep which most primary care doctor's wouldn't even think of to prescribe, even though it is an old and safe medication that has been around for a long time. I have also been on Vistaril. I took it while doing a trauma intensive program. It's technically and antihistamine, but worked well for many people at the trauma treatment program because it helped us sleep at night but not be too zonked out during the day to work through processing the trauma. Everyone is very different. In my case, both these medications worked better than klonpin for me in reducing symptoms.

Due to the Mental Health Parity Act in the US, your insurance should cover an in-network psychiatrist at the same rate they would cover a primary care doctor. I used to work in health care, and I have never seen an insurance company deny seeing a psychiatrist because someone was already seeing a therapist. They go hand in hand for a lot of people. Medication can help therapy be more effective and therapy can help medication be more effective. Insurance companies can do wacky things at times. To know for sure what your insurance will cover, your can call your insurance company and see what they do cover. Even if it does cost more, it will pay off in the long run. Getting on the right treatment will help a lot, and may mean less treatment needed overall.

You can also mention to your primary care doctor that you have been working with a therapist and you have PTSD and would like to consult with a psychiatrist. His staff can help navigate finding one and getting it covered by insurance. It may feel embarrassing to tell him, but they actually hear about this kind of stuff a lot and often help people get connected to good psychiatrists.

When you see a doctor for medications, they usually will intentionally avoid processing through the trauma. That would naturally be very triggering and unsettling. It's best done in therapy. There are a few docs here and there that do therapy in addition to medication management but they are few and far between in the US. If you look for a doc and explain you are working on the trauma in therapy and you are just there for "medication management" - then they will very likely stay away from prying too much. I have seen a handful of psychiatrists and they never really ask about the trauma in any detail. They are pretty ok with knowing there is trauma, and I'm working on it with a therapist. Then we talk about symptoms - how well am I sleeping, eating, feeling, functioning, etc. Then we talk through medication options, and the pros/cons of each option. It's very different than therapy and very focused on symptoms.

I think a psychiatrist would be a particularly good option in your case as they can really evaluate if SSRI's are a good route or not, and what medications will help reduce symptoms and yet allow you to process in therapy and generally not feel like a zombie. They will know about a lot more options than your primary care doc.

You have already taken a lot of very good steps - keep up the good work as you sort through all of this!

 

[Haileesmom]

Thank you both so much for clearing all that up for me. It all makes perfect sense and I'm definitely going to see about finding the right psychiatrist to help manage this. No one has explained any of that part in detail to me before now so that helped a ton. This is a very supportive community, I'm glad I joined!

 

[joeylittle]

Most psychiatrists don't do counseling...Many are also more than willing to team care with your psychologist... So they confer based on what you tell your therapist, and you just need to basically confirm those notes, and add anything missed or misspoken. It's a pretty impersonal arrangement in my experience.

Just wanted to add an opposite experience. Sometimes I wonder if she's a unicorn, but my psych (who also does therapy) is incredibly conscientious, sees me every two-three weeks for medication management, and when I'm going through a bad patch or we are changing something, sees me for a therapy session or two in addition to stepping up the med management to once weekly.

She recommended my current therapist to me; she's also placed me with other colleagues of hers when I've been working in different cities for extended periods, and they are all equally as awesome.

The very first psych I saw was horrible, impersonal, and I just assumed it was like that. Then I got really lucky and found my current one. I can truly say that my therapist, psych, and other specialists I've dealt with have all worked as a great team. You do have to do some looking - and you might need a therapist with more specialized training as well (not necessarily, I just know I hit a point where the LSW I was seeing felt like she was way over her head with me).

Welcome to the forum!

 

[Haileesmom]

Thanks! I'm going to ask my therapist to recommend a psych for med management. She's really awesome and I feel comfortable working with her. She's dedicated her career and training specifically to PTSD and has a lot of experience with my particular type of trauma. I did a lot of research finding her cause the first one I went to 8 years ago was horrible and was in over her head I think and that caused me to run from therapy and wait 8 years before getting the courage to try again. I did NOT want a repeat of that. It's really hard finding a good fit for a therapist with stuff like this because it's such a hard process.