To date, there is no single or specific treatment recommendation for psychological trauma. Treatment depends on a number of factors including previous exposure to trauma, the extent and nature of the trauma, the strength of reaction to trauma, and the level and type of support available to the individual following a traumatic event.
One of the first treatment options to be considered by doctors is medication. Specific medications are available for anxiety and depression so medication as a treatment choice is perfectly understandable. To date however there are no medications available to treat the complex symptoms of post-traumatic stress disorder (PTSD). So far, attempts at combining or mixing medications within the context of a properly controlled study are quite limited. This highlights a more general issue with PTSD which is that its treatment is not well researched.
For medication to be effective in PTSD it has to achieve several things. First, the severity and frequency of symptoms has to be stopped or at least reduced. It has to improve states of depression and mood numbing and reduce psychotic or dissociative behavior. Furthermore, it needs to reduce the arousing effects that events, situations or sensory information can trigger as a reminder of the trauma.
A lot of attention has been paid to the sympathetic arousal system. The sympathetic nervous system activates our fight-or-flight response. Prolonged activation can cause a release of adrenaline which then binds to certain receptors and causes the effects we associate with fight-or-flight. Both propranolol and clonidine have been shown to reduce sympathetic arousal . The trials conducted with these drugs have shown some promise in reducing, for example, nightmares, hypervigilence , insomnia and angry outbursts.
Selective serotonin reuptake inhibitors (SSRIs) may also be prescribed. Some studies have shown serotonin abnormalities in PTSD patients and this is associated with the some of the symptoms (depression, suicidal thoughts, aggression) that frequently accompany PTSD. To date, only the SSRI group of medication appears to have a positive effect on lifting numbing sensations, separate from depression.
Despite the frequency with which they are prescribed comparatively little research evidence supports the use of benzodiazepines such as alprazolam and clonazepam. Such medications are prescribed for the reduction of anxiety and fear and do, according to the few studies available, seem to help with anxiety, irritability and hyperarousal. Unfortunately this group of medications are also well known for their withdrawal effects, so their use needs to be carefully monitored.
Medication is recognized as having a valuable role in the treatment of PTSD because it can, and does, reduce the severity of symptoms. It cannot however be considered a cure for PTSD. Evidence to date suggests that medication has a suppressing effect on symptoms and that once medication is stopped the worst of the symptoms may reappear. Medication can also have troubling side effects. In summary therefore medication is probably best thought of as a useful tool that forms a part of a more comprehensive treatment package.
Resnick P.A (2001) Stress and Trauma. Psychology Press.
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