PTSD: The Soldiers Private War

The following is an excerpt. Read the full version here. Samuel Pepys was a member of parliament and a high-ranking figure in the Admiralty, where he was instrumental in strengthening the Royal Navy, but he is best remembered as a diarist. His account of the Great Fire of London, which razed the area where the city – the financial nexus of the United Kingdom – now stands, is perhaps the definitive eyewitness narrative of the tragedy. Fully six months after Pepys saw the Great Fire devour people and buildings, his sleep was broken by nightmares of the horror. Today we would say that Pepys was probably suffering from post-traumatic stress disorder (PTSD), the mental state that we associate with the broken military dribbling back from 12 years of war in the Middle East. PTSD denotes a psychiatric illness that follows a physical or psychological trauma, like seeing your buddy’s legs blown of by a roadside bomb. But PTSD is older even than warfare; it is probably as old as anxiety itself. However, wars have been a propitious time for studying PTSD, not least because physicians encounter so many more cases of it. The term PTSD entered the official lexicon of psychiatric diseases in the 1980 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) and underwent revision in the subsequent edition of the manual; today, clinical psychiatrists, many researchers, disability evaluators, the courts and, for better or worse, anyone else who requires a standardized set of criteria, rely on DSM-IV. […] It is especially interesting, therefore, that antidepressants constitute front-line therapy for patients with PTSD. These days, psychiatrists generally use specific serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac or Paxil, or a specific serotonin/noradrenaline reuptake inhibitor, notably the drug Effexor. To these, in his clinical practice, co-author Knoll may add low doses of a second generation antipsychotic, of which the most familiar are Abilify, Seroquel or Zyprexa. Antipsychotics are not curative in themselves, but they enhance the effectiveness of antidepressants. A third drug in Knoll’s armamentarium is Prazosin. Though marketed as an antihypertensive, practitioners and patients have found Prazosin effective at blocking nightmares. Of particular interest is a study by Michael H. Mithoefer, MD that MDMA (a k a ecstasy) was found to be highly effective for treating PTSD in combination with psychotherapy. And at the University of Arizona, Sue Sisley MD, a psychiatrist and internist, is awaiting delivery of a supply of marijuana from the National Institute on Drug Abuse (NIDA) to begin a trial approved by the Food and Drug Administration (FDA). There has been some interest in propranolol (Inderal) for “erasing” PTSD-type memories, but this is based on anecdotal accounts and small-scale studies. On the other hand, propranolol can cause vivid nightmares – the last thing you’d want in a patient with PTSD. Read the full version here. TruthOut takes a detailed look at posttraumatic stress disorder (PTSD), reviewing traditional treatments and exploring new, innovative treatment methods. The article highlights MAPS’ research proposal for treating PTSD with medical marijuana at the University of Arizona, as well as our promising studies using MDMA-assisted psychotherapy as a treatment for PTSD.