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Common PTSD Drug May Be Useless

schart28

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Interesting article:

http://www.medicinenet.com/script/main/art.asp?articlekey=77880


In its eight-week study, Neylan's group compared the effects of guanfacine and an identical-looking placebo pill in 63 male and female veterans diagnosed with PTSD. Twenty-nine participants were randomly picked to take guanfacine while the other 34 took the dummy pill.

By the end of the study, the researchers found no net difference between the two groups in terms of changes in symptoms


 

TCBF

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They should try alcohol - worked for generations of Canadians.
 

the 48th regulator

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How about we all knock it off.

You have something of substance to add, then do it.  You want to fool around, head over to Radio Chatter.

dileas

tess

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OldSolduer

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the 48th regulator said:
How about we all knock it off.

You have something of substance to add, then do it.  You want to fool around, head over to Radio Chatter.

dileas

tess

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AGREED!
We tend to treat subjects such as this with "dark humour" which I beleive our participants are doing. Its not appropirate though.
 

mariomike

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TCBF said:
They should try alcohol - worked for generations of Canadians.

I'm not a brain specialist, or trying to make light of a serious subject, but this article, as I understand it, seems to provide some scientific evidence in support of my long held personal belief, and practice, that a couple of drinks, in a quiet, dark, familiar place among friends, after duty, may not be such a bad thing. After all, they do call it, "The Happy Hour". Whatever hour of the day or night it may happen to fall on. 
"We're debriefing here. Like they do with the astronauts."  < just kidding >
As I said, I'm not an expert. Just my personal opinion.:
"Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate this endorphin withdrawal and thus avoid the associated emotional distress.":
http://www.enotalone.com/article/11325.html



 

medicineman

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To Schart, unfortunately the link didn't bring the study up - though I'd hasten to guess that an 8 week study with a very small cohort doesn't show alot of statistical validity for a drug that, like anything else that works on neurotransmitters, can take up to 8 weeks to start showing results.  I know I drooled with a 4 headed alien look on my face through my bio-stats class, but I'd say the jury shouldn't have returned quite that early.

Alcochol is a neat thing - it helps people get stuff off their chests by lowering inhibitions, which might be a good thing in some people's cases.  However, what's one of the hallmarks of PTSD?  Sleep deprivation due to intrusive memories, nightmares, etc.  What does alcohol do - it inhibits REM sleep.  The REM cycle is where the brain processes what's happened to us over the last little while and tries to make sense of things...alcohol will make you sleep, but not well, which is one of the reasons you wake up feeling the way you do after a bender - no REM.  Perversely, alot of PTSD sufferers drink hoping they'll sleep, even a bit, but really tend to make things worse because they don't get the REM sleep they need for their brains and minds to sort out what the hell's happened to them.  I liken it to a computer that needs defraging - information needs to be processed but can't because something else is ahead in the qeue or it is stuffed somewhere else, so there is a backlog that builds and builds.  Proper counselling and finding the medications that work for the patient help them to "defrag" the brain.  Of course, sometimes just having a few drinks with people you can trust in a safe place can help you get things of your chest and hopefully get on with life...other times, not really.  Each person is different.

:2c:

MM
 

Cdnleaf

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medicineman said:
Alcochol is a neat thing - it helps people get stuff off their chests by lowering inhibitions, which might be a good thing in some people's cases.  However, what's one of the hallmarks of PTSD?  Sleep deprivation due to intrusive memories, nightmares, etc.  What does alcohol do - it inhibits REM sleep.  The REM cycle is where the brain processes what's happened to us over the last little while and tries to make sense of things...alcohol will make you sleep, but not well, which is one of the reasons you wake up feeling the way you do after a bender - no REM.  Perversely, alot of PTSD sufferers drink hoping they'll sleep, even a bit, but really tend to make things worse because they don't get the REM sleep they need for their brains and minds to sort out what the hell's happened to them.  I liken it to a computer that needs defraging - information needs to be processed but can't because something else is ahead in the qeue or it is stuffed somewhere else, so there is a backlog that builds and builds.  Proper counselling and finding the medications that work for the patient help them to "defrag" the brain.  Of course, sometimes just having a few drinks with people you can trust in a safe place can help you get things of your chest and hopefully get on with life...other times, not really.  Each person is different.

:2c:

MM

Appreciate the above on this one.  As you know, depression and Alcoholism are the two major comorbid conditions associated with PTSD.  VAC has some great reading on this as well, http://www.veterans.gc.ca/eng/sub.cfm?source=mental-health/support/factsshh

The challenge with initial treatment is: where to start due to the iceburg nature of PTSD, initially treatment is focused exclusively on stabalization (damage control in a sense) and containment of the physical/pschological/psysiological effects of PTSD.  I previously attempted depict the PTSD iceberg, based on available information from VAC/LCol (Dr.) Jetly.  All the best, thanks for keeping things on track.

ptsdiceberg.jpg


 
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Perhaps a more multifaceted approach to the initial treatment of PTSD would yield significantly better results than this medication.

A medication regimen tailored to the patient would be better than a 'one pill cures all' approach. I would imagine that concomitant usage of one of the major antidepressant families, atypical antipsychotics (if required and in the lowest therapeutically-effective dose) and mood stabilizers (if required) would be a potential route for aiding in the treatment of PTSD. Benzodiazepines are highly risky, and should only really be used if absolutely necessary; alpha or beta blockers could be used as anxiolytics, as could hydroxyzine or buspirone. For issues such as insomia, a non-benzodiazepine medication such as zopiclone would be effective, whereas trazodone, in my opinion, should be completely avoided due to its penchant for inducing extremely vivid dreams and nightmares. Again, benzodiazepines are highly risky should they be used to treat insomnia due to their inherent risks plus the risk of violent black-outs and acute intoxication that essentially mimics alcohol.

However, all of these pills aren't the cure-all, therapy (e.g. CBT) is absolutely essential. PTSD is by no means an easy condition to treat. It requires a multidisciplinary approach to treatment and consistent follow-up and strong support mechanisms for the patient. It can take years to treat, and the whole concept of this guanfacine being the one pill miracle cure is pure rubbish.

Having read up on guanfacine, I think that it's simply not an ideal pharmaceutical agent for PTSD. Limited effectiveness and high occurrence of side effects are the hallmarks of a poor medication (no brainer).

I'm not an MD, but I'd really love to hear feedback on potential multifaceted treatment options besides guanfacine from medical and mental health professionals.
 
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