Past Trauma: Post-Traumatic Stress Disorder : Part 3

by Food and Drug Administration (FDA)

(Page 3 of 3)

First PTSD Drug

Before its approval last December for post-traumatic stress disorder, Zoloft was already approved by FDA for depression, panic disorder, and obsessive-compulsive disorder. Its effectiveness for PTSD is in line with its benefit for depression and the other disorders, says FDA's Laughren. Studies show that about two-thirds of PTSD patients improve with Zoloft, while one-third improve when taking a placebo.

Zoloft's approval for PTSD was based on two 12-week studies of the drug that demonstrated its effectiveness. While Zoloft's benefit over placebo was clear in women patients, little effect was seen in the male group. Scientists aren't certain why the gender difference exists, but some have theorized that PTSD in veterans, a mostly male population, might differ somehow from the disorder in the mostly female population of sexual assault victims.

After her rape, Greene says, Zoloft played a big part in helping her heal. "It really took the edge off. I had been playing the attack over and over in my mind, like a broken record, and Zoloft helped me get out of that groove. It didn't make me a zombie or make me ecstatically happy, either. But all of a sudden I woke up and said, 'I can handle the day.'"

Greene took Zoloft for about a year, which was within the typical range of six to 24 months. She didn't notice any bothersome side effects, though some people do experience dry mouth, nausea, sleepiness, or other negative reactions.

While Zoloft is the only drug approved by FDA to treat PTSD, doctors sometimes prescribe other drugs that they believe may improve a patient's condition. For PTSD, doctors sometimes prescribe drugs in the same class as Zoloft. These selective serotonin reuptake inhibitors, or SSRI's, include Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), and Celexa (citalopram). Based on an individual patient's medical circumstances, a doctor may in some cases choose to prescribe other types of antidepressants or anti-anxiety medications.

Facing Fears

As an alternative to medication or coupled with it, some patients opt to rely on group or individual psychotherapy to manage their PTSD symptoms. Three types are considered especially effective, according to the expert consensus guidelines:

Exposure therapy. To help patients confront the everyday reminders of their trauma, therapists sometimes use "exposure in the imagination" or "exposure in reality." In the first type, patients imagine the trauma and recount the memories in detail, over and over again, with a therapist they trust and at home between sessions. The goal of therapy: to give people an opportunity to reprocess what happened until the thoughts lose their distressful impact. Lyn Rezer, 35, re-examined a traumatic gang rape that had occurred when she was 12 years old and had haunted her for more than 20 years. Using this approach, Rezer says she conquered her feelings of worthlessness and despair. "I walked around for 23 years feeling extremely suicidal, wanting to flee, wanting to cry. I thought I was bad, I was filthy, I was nothing. I detached myself emotionally from a lot, and today I'm not detached. I feel everything, like a normal 35-year-old woman with normal impulses and instincts. I haven't had a suicidal thought since midway through treatment." With exposure in reality, therapists ask patients to gradually expose themselves to situations or places they had been avoiding because they are reminders of the trauma.

Cognitive behavioral therapy. With CBT, therapists work on changing victims' irrational beliefs, such as self-blame for a rape, criminal assault, or accident.

Anxiety management. This classification refers to techniques such as slow abdominal breathing to relax and avoid hyperventilation, and positive thinking and self-talk to replace negative thoughts.

Therapist Foa, who at her University of Pennsylvania clinic uses exposure therapy, sometimes combined with other types, estimates that 80 percent of patients accomplish significant improvement in their lives over the 12 weeks or so of therapy.

Foa acknowledges that it's difficult to directly face a traumatic memory that one has been avoiding, sometimes for years. But getting help is critical, she says, if the stifling symptoms of PTSD do not resolve themselves pretty quickly after a trauma. Immediately after the trauma, it's normal to experience emotional swings, Foa says, so "you needn't rush to treatment." But if your symptoms begin to appear chronic, at four to six months, she says, they're not likely to improve on their own.

In light of the healing effects of PTSD treatment in her own life, rape survivor and rookie sky diver Greene has committed herself to encouraging others to take brave steps to deal with their traumatic memories. Greene says she has been inspired by popular singer Tori Amos, a rape victim herself and co-founder of the trauma support organization RAINN (the Rape, Abuse and Incest National Network). Amos, who says she wrote her song "Me and a Gun" as a healing step for herself, wrote a public letter to others who have faced similar traumas. The message: "Healing takes courage, and we all have courage, even if we have to dig a little to find it!"

It's worth digging up the courage, Rezer confirms. "It's a lot of hard work, but your life doesn't have to be dictated by your past. I never believed you could go back in time and change things, but I know now that you can change them — not the events, just the feelings and thoughts surrounding them that have taken over your life."

About the Author

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