Q: I keep reading about our military people coming back from the war in Iraq suffering from post-traumatic stress disorder. What exactly is this and is there any treatment?
A: Common harmful events, such as touching a hot stove, lay down memory traces in the brain as a normal protective mechanism.
Horrific traumas, such as those that occur in a war zone, may leave the affected neuronal pathways in an abnormally hyper-vigilant state. That sets the stage for the haunting flashbacks and nightmares, startle reactions, insomnia, angry outbursts and other symptoms associated with post-traumatic stress disorder or PTSD.
Why do some individuals develop PTSD after an overwhelming trauma and others don’t? As with most disorders, some people are innately more vulnerable.
Genes involved in creating fear memories have been implicated. A gene that controls levels of serotonin, a neurotransmitter involved in mood, may help fuel the fear response.
Brain areas thought to play roles in PTSD include the amygdala and the prefrontal cortex.
The amygdala, an almond-shaped structure deep within the brain, is involved in both learning to fear an event and in “unlearning” a fearful memory.
The prefrontal cortex, involved in judgment, decision-making, and problem-solving, influences the response to stress. It puts the brakes on the amygdala, preventing it from overreacting. Another part of the prefrontal cortex helps abolish fearful memories.
Psychotherapy and medications are used to treat PTSD.
Cognitive behavioral therapy is the most-used form of psychotherapy.
The serotonin-specific antidepressants sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved to treat PTSD. A current study is comparing sertraline and cognitive behavioral therapy to see which might work best.
One small study found that prazosin (Minipress), a medication used for high blood pressure and enlarged prostate, helped alleviate PTSD symptoms.
Another small study found that the antibiotic cycloserine (Seromycin) could potentially help by boosting the activity of a chemical required for fear extinction.
The beta-blocker propranolol (Inderal), widely used for high blood pressure, angina and irregular heart rhythm, seems to help block the neuronal encoding of fearful memories. The drug has been used to reduce or prevent PTSD in trauma victims.
It’s been reported that Iraqi war veterans with PTSD symptoms may be reluctant to seek help because of the stigma associated with mental disorders. Tragically, some have committed suicide.
Part of this problem lies with the pervasive view that “mental” disorders are not quite as real as “physical” disorders (e.g., diabetes).
But that’s just plain incorrect. The mentality is a physical process carried on by parts of the brain. We know that thoughts and emotions are generated by chemicals (neurotransmitters) squirting between neurons. The mind is a part of the body. Therefore, mental disorders are physical disorders.
No shame or stigma need be attached to PTSD and other mental disorders. Returning combat veterans weighted with such burdens deserve the best treatment this country can provide.
