What is PTSD? - June 13th, 2022 Episode

Updated: Oct 17





APA def: Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury, losing a baby in childbirth.

Emotional abuse/gaslighting

Shell shock, combat fatigue,

3.5% US adults annually (12,250,000) 37% of these considered severe

1/11 people will be diagnosed in their lifetimes

W:M 2:1

White << Latino, black, Amerindian https://psychiatry.org/patients-families/ptsd/what-is-ptsd

Gay>>>straight 2-4:1 https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2011.300530?searchHistoryKey=&prevSearch=%5Bauthor%3A+Austin%2C+S.+Bryn%5D


What are the symptoms?


Intrusion: involuntary memories, dreams, flashbacks

Avoidance: people, places, activities, objects, situations

Changed cognition or mood: “I am bad,” “No one can be trusted,” fear, shame, guilt, horror, anger, apathy, detachment from relationships, sadness, anxiety

Altered arousal: hypervigilance, reckless, startle, self-destructive, concentration problems, insomnia

Last over a month

Cause significant difficulty with daily function

Self-medication: drug and/or alcohol abuse

Does it change the brain?


Emotional trauma and PTSD cause brain and physical damage

Amygdala (fear) hyperactive, hippocampus (memory) shrinks in volume, prefrontal cortex (rational, emotional processing) is overridden by amygdala

What are the treatments?

Cognitive Behavioral Therapy:

Cognitive processing - confront negative thoughts/emotions to modify

Prolonged exposure - repeated detailed imaging like VR - has helped some vets

Stress inoculation - teaches coping skills

Group - sharing with others can help

Serotonergic agents promote structural changes and functional plasticity: This means that the chemicals like SSRIs and psychedelics help the brain to heal after emotional trauma

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082376/.

Medication:

Some SSRIs - paroxetine, selegiline, off label venlafaxine

Atypical antipsychotic - quetiapine

https://www.frontiersin.org/articles/10.3389/fphar.2020.00559/full

Psychedelic therapy:

MDMA - methylenedioxyMETHAMPHETAMINE Empathogen/intactogen

MAPS: In our first Phase 3 study, 88% of participants with severe PTSD experienced a clinically significant reduction in PTSD diagnostic scores two months after their third session of MDMA-assisted therapy, compared to 60% of placebo participants.

Additionally, 67% of participants in the MDMA group compared to 32% of participants in the placebo group no longer met the criteria for PTSD remission two months after the sessions. https://maps.org/mdma/ptsd/

Psilocybin - “magic mushrooms” are a very positive step in therapy. The Johns Hopkins Center for Psychedelic & Consciousness Research has excellent evidence for life-changing results. https://hopkinspsychedelic.org/index/#research

Ketamine - is not as promising. https://www.frontiersin.org/articles/10.3389/fpsyt.2022.813103/full

Nutrition:

N-Acetyl Cysteine - higher evidence of effect than paroxetine and quetiapine.

2400 mg daily for eight weeks https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226873/