It has been quite a journey for PTSD patients, and it is not over yet. However, we have reached an important milestone. Most doctors now acknowledge that PTSD is a physical injury, much like a concussion or another kind of brain injury. Stress creates a chemical imbalance in the brain. This chemical imbalance causes symptoms like hypervigilance, anger, flashbacks, depression, and other out-of-control emotional symptoms. Sadly, these symptoms also include suicidal thoughts.
Also, sadly, many injured contractors and doctors are not up to date on this latest science. As a result, some victims self-medicate with drugs or alcohol. This approach deadens their senses and works in the short term, but over the long term, it is destructive. Furthermore, if they see their doctors, they usually focus on the “disorder” component of PTSD and do not give these people the treatment they need.
A Defense Base Act lawyer is an important partner in these situations. Lawyers connect injured overseas contractors with doctors who understand that their condition has a chemical cause and, therefore, a chemical cure. Some of the most effective chemical cures are still in the experimental phase, which is why a doctor who focuses on such conditions must carefully supervise medical treatment.
What Causes PTSD?
Military service, and more specifically, military action, is the leading cause of PTSD. About a fifth of combat veterans struggle with the aforementioned symptoms. Usually, combat stress hits victims like a tidal wave. Contractors are talking about sports one minute and fighting for their lives the next minute. That sudden, jarring transition is more than the brain can handle, at least in many cases.
It helps to understand PTSD when one realizes that non-combat events also cause this brain injury. These events include:
- Car Crashes: Almost half of car crash victims develop PTSD. These events are similar to combat stress in many ways. While Alan waits to cross the street, he sees an out-of-control vehicle barreling in his direction. That is not something you can unsee.
- Unexpected Death of a Loved One: Grieving people who develop PTSD usually lose their loved ones to a completely unexpected trauma injury, like a car crash or mugging gone badly. Other deaths are stressful but not as stressful. If Laura is an overseas contractor, her family knows there is a chance she will not come home alive.
- Life-Threatening Illness: This time, it is personal and also varied. Medical conditions associated with an increased risk of PTSD include cancer, heart attack, and stroke. Intensive-care unit (ICU) hospitalization is also a risk factor for PTSD. Some women experience PTSD from their experiences related to breast cancer and mastectomy.
- Psychotic Episode: Survivors of psychotic episodes, which exist in diseases such as schizophrenia, schizoaffective disorder, bipolar I disorder, and others, are at greater risk for PTSD due to the experiences one may have during and after psychosis. Such traumatic experiences include the treatment patients experience in psychiatric hospitals, police interactions due to psychotic behavior, suicidal behavior and attempts, and frequent terrifying experiences due to psychosis.
Additionally, some victims are genetically predisposed to PTSD, like some people are genetically predisposed to other physical illnesses. Some researchers believe that up to a third of PTSD cases are genetic and nothing else. One study examined twins who survived combat in Vietnam. A monozygotic (identical) twin with PTSD significantly increased the risk of PTSD in the co-twin.
For DBA purposes, if a genetic or other pre-existing condition contributed to the risk and/or severity of PTSD, maximum benefits are usually available. These benefits include lost wage replacement and medical bill payment.
What Treats PTSD?
As mentioned, this chemical-induced brain injury has a chemical solution. However, at this time, these chemical options are limited. Furthermore, we should not ignore individual and/or group therapy. In some cases, therapy is almost as effective as medication, especially if the victim’s PTSD is relatively mild.
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.
SSRIs are typically the first class and only class, of medications in PTSD treatment. However, exceptions may occur for patients based on their individual histories of side effects, responses, comorbidities, and personal preferences. Examples include:
- If a patient has PTSD and co-occurring bipolar disorder, antidepressants could cause mood instability that requires additional medication to control.
- Higher serotonin levels could cause intolerable sexual dysfunction or gastrointestinal side effects in the peripheral nervous system.
- Other antidepressants, such as venlafaxine, that affect the balance of serotonergic and noradrenergic neurotransmission or alter serotonin neurotransmission through other mechanisms of action are also helpful.
A few other drugs are, or may become, available. Topiramate is in the anti-epileptic category of medications and is thought to modulate glutamate neurotransmission. There has been recent interest in its use for PTSD. The systematic review that served as the evidence base for the guideline development panel reported moderate strength of evidence for a medium to large magnitude effect for PTSD symptom reduction.
Psychotropic drugs, such as LSD, have shown some promise in limited studies, as has marijuana. However, because these drugs are illegal almost everywhere, the research is too limited to support any firm conclusions.
Each patient varies in their responses and abilities to tolerate a specific medication and dosage, so medications must be tailored to individual needs. Research indicates that the maximum benefit from SSRI treatment depends upon adequate dosages and duration of treatment. Ensuring treatment adherence is key to successful pharmacotherapy for PTSD.
For more information about other covered DBA injuries, contact Barnett, Lerner, Karsen, Frankel & Castro, P.A.