It's important to know that Antidepressants will not be effective unless in the correct range...and that that range differs at least somewhat, and often widely, from one person to another. As an example, Sertraline (Zoloft) is indicated for obsessive compulsive disorder and anxiety at 50mg., but at 100mg for depression. In other words, just because you've tried SSRIs at one level, doesn't mean that that's all there is to expect from them. In fact, if SSRIs have been somewhat effective for you, chances are you're on the right track, and that a different dose would improve symptoms which you've taken for granted as intractable. For example, many who find their anxiety inadequately controlled at 100mg of Sertraline find significant relief from the same symptoms at 200mg. I speak from experience, and use Sertraline as an example of an SSRI because that's what's worked best for me, personally.
SSRIs increase the levels of Serotonin which run low in those with PTSD due to a reduction in Hippocampal volume, which typically accompanies PTSD, the Hippocampus being responsible for much of the Serotonin in the brain.
Many benefit from increasing levels of Dopamine, as well, for different reasons. Dopamine receptor density in the prefrontal cortex also decreases as a result of PTSD in most, making an increase in Dopamine levels important in reducing depressive symptoms, as well as nervousness and anxiety. While ADD meds in the form of stimulants...Adderall, Ritalin, Vyvanse...are the generally the first go-to to increase Dopamine levels, other medications can be used, as well, Wellbutrin (buproprion), for one. However, it's important to note that Wellbutrin has a NRI component as well (Norepinephrine) which is enhanced at higher dosages, and which can trigger symptoms in PTSD, as it has effects similar to Adrenaline. Older antidepressants, known as Tricyclics, can affect catecholamines in general, raising levels of a number of different neurotransmitters, Serotonin and Dopamine among them, and have proven more effective than newer psychotropic medications for many. Pamelor and Amitryptaline have proven effective in treatment of PTSD symptoms, especially. Amitriptyline in particular has been helpful in reduction of symptoms of nervousness and sleeplessness. Many pdocs (psychiatrists and other prescribers of psychotropic meds) fail to consider such older medications, and must be reminded.
Beta-blockers and alpha-blockers, such as Clonidine, mentioned in a previous post, can benefit those suffering from the "adrenalization" of PTSD (sensitivity to adrenaline and gluccocorticoids) due to their ability to dull this sensitivity, in essence, and so allay symptoms. Guanfacine is another option within this class, which is also accompanied by greater drowsiness, making it better suited for doubling as a sleep aid.
Lastly, Prazsosin, another blood pressure medication, has proven particularly effective in inhibiting nightmares associated with PTSD.
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