Adrenaline and Post Traumatic Stress Disorder (PTSD)

NOVANEWS

by Ed Mattson

Group counseling to adjust to civilian society

Last night on CBS’ 60 Minutes one of the segments was devoted to Adrenaline. This was a repeat of a previous show and the second time I watched it. The program showed how laboratory rats, when placed in a tub of water kept swimming close to the edge of the tub. There was a safety platform in the center of the tub where there would be no fear of drowning, yet the rats didn’t immediately swim to the safety of the platform. Once shown the platform, they willingly sought the middle of the tub on their next encounter with the water.

The learning experience became re-enforced because of the high level of adrenaline that the rat produced showing that adrenaline is a key to long-term memory of life-threatening or shocking experiences. From this brief experiment one can say that adrenaline may be the most powerful mind altering drug known to man and when frightened this chemical reaction runs its super powerful course in pursuing “survival reaction”. The worst effect of adrenaline may be that one’s brain may become addicted to that same rush of adrenaline creating a dependency effect. In this manner it is easy to see how post traumatic stress disorder, with its flashbacks, hyper tension, and sometimes feeling of invincibility can take complete control over the body. As stress builds the body unconsciously and automatically produces more adrenaline which each subsequent experience.

Many of those in the military who have experienced combat can relate to the feeling of adrenaline production that fear can produce, and understand the feeling of an almost euphoric state as the body goes into survival mode. The high level of intensity created by traumatic events may then become a “need” that almost has to be fed. I can now understand how, back in the Vietnam era, we saw many of our fellow warriors volunteer for multiple tours of duty in the combat zone. They became addicted to the action. While adrenaline may be the one element that instills survival, it can also destroy the lives of those warriors when they have to return to the mundane world of civilian life.

As more and more is learned about PTSD, we are developing ways to best treat it. I believe the jury is still out when it comes to actually “completely cure” a patient with post traumatic stress disorder, so the goal seems to be to provide continued support and guidance so the individual can become a functioning member of society.

Psychotherapy has as its purpose to help the individual handle and deal with the overwhelming stimuli generated by the traumatic event. One very effective method is counseling that helps a patient re-live the event(s) causing the adrenaline stimulation, in a non-threatening environment. To treat a patient with PTSD, the place to start is to understand the source of the demons. This therapy part of the treatment may be required for a period lasting from six months to several years, depending on severity.

Another aspect to the counseling is educating the patient what he or she is likely to expect in the days, weeks and months ahead, so that those adrenaline related reactions can be anticipated and not further traumatize the victim. This part of the therapy can be accomplished in either individual or group debriefing session which should be lead by a therapist who is experienced both in conducting PTSD debriefings and in treating people with the condition.

As most PTSD victims experience sleep disorders caused by excessive anxiety, restlessness, anger and other symptoms that defy relaxation, the use of anti-anxiety medication like alprazolam or lorazapram, which are in a class of medications called benzodiazepines. They work by slowing activity in the brain to allow for relaxation. Sleep disorders can be managed with the short term use sleeping pills such as flurazepam or tamazepam. All these medications have the potential for abuse and addiction, so they must be used with caution.

A patient with PTSD can and most often will display significant depression when his or her mind re-lives the traumatic event(s). This is especially true if the patient feels responsibility for the event, or that there is a feeling of guilt that accompanies the feeling, such as, “why did I survive and others didn’t”. These can be very dangerous times for the patient and may lead to suicide or other self-destructive behavior, indicating more intensive treatment may be required. However, the mood altering drugs listed below also carry warnings that they may intensify the suicidal urge, so they need to be prescribed only with close supervision by the attending physician. Prozac, Zoloft, Wellbutrin, or Paxil may be very helpful in rapidly relieving depressive symptoms, reducing anxiety and restoring normal sleep. They are in a class of drugs known as selective serotonin reuptake inhibitors, and while anti-depressant medications are all non-addictive, they should only be used with close supervision.