Information About Medications

[Kizzie]

I thought I'd gather some links to info about medication for Complex PTSD.  Most info out there is for PTSD but it's what there is for now.  Hopefully this will change as researchers investigate Complex PTSD more specifically because as we know there are differences from PTSD (i.e., CPTSD has three additional symptoms). 

There is promising research being done into psychedelics such as MDMA and psilocybin, and currently Ketamine is legally being used off label to treat CPTSD, PTS, anxiety, depression, etc.  (See the discussion about psychoactive substances here - https://cptsd.org/forum/index.php?board=224.0)  However, for now in terms of medication, SSRIs are the main choice for clinicians.

The American Psychological Association

The current evidence base for PTSD psychopharmacology is strongest for the selective serotonin reuptake inhibitors (SSRIs): sertraline, paroxetine and fluoxetine as well as the selective serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine. Currently only sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD. From the FDA perspective, all other medication uses are "off label" (see footnote), though there are differing levels of evidence supporting their use.

The Mayo Clinic

Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.


US National Centre for PTSD

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are types of antidepressant medication. Medications have two names: a brand name (for example, Zoloft) and a generic name (for example, sertraline). There are four SSRIs/SNRIs that are recommended for PTSD:

Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)

There are other types of antidepressant medications, but these four medications listed above are the ones that are most effective for PTSD.

[Kizzie]

So one of the problems I am having to taking a new SSRI is increased anxiety so I looked online and found some info about this.

Marcinkiewcz, C. A., Mazzone, C. M., D'Agostino, G., Halladay, L. R., Hardaway, J. A., DiBerto, J. F., Navarro, M., Burnham, N., Cristiano, C., Dorrier, C. E., Tipton, G. J., Ramakrishnan, C., Kozicz, T., Deisseroth, K., Thiele, T. E., McElligott, Z. A., Holmes, A., Heisler, L. K., & Kash, T. L. (2016). Serotonin engages an anxiety and fear-promoting circuit in the extended amygdala. Nature, 537(7618), 97–101. https://doi.org/10.1038/nature19318

Abstract:  These results reveal an essential 5-HTDRN→CRFBNST circuit governing fear and anxiety and provide a potential mechanistic explanation for the clinical observation of early adverse events to SSRI treatment in some patients with anxiety disorders1,2.

Other Articles

How do antidepressants trigger fear and anxiety? Researchers map the anxiety circuit in the brain and use a compound to limit fearful behavior -- an acute side effect of commonly prescribed SSRI antidepressants.  From Science Daily, 2016, https://www.sciencedaily.com/releases/2016/08/160824135045.htm

Excerpt:  More than 100 million people worldwide take selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, to treat depression, anxiety and related conditions, but these drugs have a common and mysterious side effect: they can worsen anxiety in the first few weeks of use, which leads many patients to stop treatment. Scientists at the University of North Carolina (UNC) School of Medicine have mapped out a serotonin-driven anxiety circuit that may explain this side effect and lead to treatments to eliminate it.

Coping With Anxiety Caused by Antidepressants, By Nancy Schimelpfening, December 08, 2020 - "Although they're often used to treat anxiety, antidepressants can potentially cause anxiety, especially when people begin taking them for depression."

SSRIs and Benzodiazepines for General Anxiety Disorders (GAD) from the Anxiety and Depression Association of America

Excerpt: SSRIs are considered the first-line medication for GAD, and will typically be prescribed first. Benzodiazepines are considered a second-line or adjunctive medication for GAD, though are still prescribed frequently, especially when a person complains of panic attacks, sleep problems, severe muscle tension, or avoidance of specific situations due to anxiety. Depending on your symptoms, your doctor may recommend starting both an SSRI and a benzodiazepine, and then tapering off the benzodiazepine after 2-4 weeks. This may help you tolerate the initial unpleasant side-effects of SSRIs, while limiting the risks of longer-term benzodiazepine use.

[Papa Coco]

Thank you Kizzie!

These are great resources. It's tough to navigate the blossoming world of help for CPTSD / Anxiety, Depression, etc.  Where we were once on our own with only trickles of possible help, now we're being helped by a firehose of new information and therapies. The barrage of possible treatments (and their possible side effects) sometimes feels overwhelming to me.