Скачать или смотреть PTSD Medications: Integrating Pharmacotherapy, Therapy, & Treatment Frame | Psychofarm Podcast

Explore psychiatric insights into PTSD medication management, covering common meds like SSRIs and sleep aids, the importance of stabilization and trust in trauma treatment, and its integration with psychotherapy based on clinical experience.
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(00:00) Introduction: Trust & Teaching Styles
(01:53) PTSD Treatment Overview: Goals, Med Limits & Evidence
(07:14) Medication Algorithms: Standard vs. Clinical Approach (Incl. Benzos)
(09:46) Clinical Strategy: Prioritizing Sleep Stabilization
(11:30) Common Sleep Medications & Rationale (Trazodone, Gabapentin, etc.)
(14:39) Antipsychotics & Differentiating Complex Presentations (Psychosis/Dissociation/Mania)
(19:29) SSRIs, Buspar, and Other Medication Considerations
(21:06) Psychoeducation: Avoidance, Safety & Predictive Coding
(25:07) Clinical Anecdote: ER Trauma & Processing
(31:08) Med Wrap-Up: Tapering, Symptom Targets & Mirtazapine/Trazodone Notes
(36:04) Managing Dissociation: Acceptance & Grounding Techniques
(39:12) The Pierre Janet 3-Stage Model of Trauma Treatment
(42:47) Establishing the Treatment Frame & Setting Expectations
(49:18) Handling Therapy Resistance & Maintaining Boundaries
(55:41) Final Thoughts & Supporting the Podcast

Join us for a comprehensive discussion on the complex world of PTSD medication management from a clinical psychiatry perspective. While trauma treatment ideally involves psychotherapy and lifestyle changes, medications often play a crucial supportive role, particularly in achieving initial stabilization, trust, and safety.

This episode tackles the reality of treating PTSD with medication:

Limited Evidence & Off-Label Use: We acknowledge the surprisingly low evidence base for many PTSD drugs and the prevalence of off-label prescribing beyond the few FDA-approved options (Sertraline, Paroxetine).
Focus on Stage 1: Medications are highlighted as primarily beneficial for Stage 1 (Stabilization) of the Pierre Janet trauma treatment model, helping manage acute distress, improve sleep, and enable engagement in therapy.
Sleep is Key: Severe sleep disruption (nightmares, fear of sleep) is a common and debilitating symptom of PTSD. Learn about preferred agents like Trazodone, Gabapentin, Hydroxyzine, and even blood pressure medications (Propranolol, Prazosin, Clonidine) or Topamax to restore sleep, often being the first line of intervention. Mirtazapine is also discussed as a potent option if weight gain isn't a concern.
SSRIs: The role of SSRIs like Sertraline is explored – often effective but slower acting, requiring adequate dosing. Reasons for avoiding Paxil (weight gain) are mentioned.
Antipsychotics: When are antipsychotics (like Seroquel, Risperdal, Zyprexa, Abilify, Lurasidone, Brexpiprazole, Cariprazine) considered? Primarily for severe PTSD co-occurring with distinct Major Depressive Disorder (especially with psychotic features) or Bipolar-like presentations, rather than as a first-line approach.
Dissociation vs. Psychosis: A key discussion point is differentiating dissociation (often treatable with sleep support/anxiolytics like Buspar) from true psychotic features in PTSD, cautioning against reflexively using antipsychotics for all perceptual disturbances. Don't chase zero symptoms with dissociation; focus on reducing distress.
Benzodiazepines: Strong caution against using benzodiazepines, as they can hinder long-term recovery despite short-term symptom suppression.
Beyond Meds: The conversation emphasizes that medication is support, not the cure. The crucial roles of trauma therapy (processing and integration stages) and lifestyle changes (activity, safe socialization, avoiding triggers) are stressed. Concepts like predictive coding are used to illustrate how new experiences help recalibrate threat responses.
Clinical Approach: Insights into establishing a clear treatment frame, managing patient expectations, using motivational interviewing for resistance, the importance of grounding techniques (active ones preferred for dissociation), and differentiating the psychiatrist's medication management role from the therapist's role are shared.
This discussion offers valuable insights for clinicians, trainees, and individuals seeking to understand the nuances of psychiatric mental health care for trauma and PTSD.