Prazosin "Off Label" Use For PTSD

I have been experiencing some intrusive thoughts, extended periods of dissociation, attention difficulties, traumatic memories, avoidance strategies, numbing and hyperarousal. Yeah, I have PTSD. Anyway, it's getting to me so I did some research on drugs that may help and came across Prazosin. I had tried fluvoxamine two times a couple of months ago and could not tolerate the side effects. They made me feel heavy headed and faint, so I ditched them. Now, with therapy in progress I needed to get some symptom relief so I can concentrate again in school and in life.

Originally a drug for hypertension and now is used "off label" for PTSD symptoms including; nightmares, reexperincing, avoidance, numbing and hyperarousal. I couldn't have found one more perfect. I will have to see how well I tolerate the side effects, but the study that I read says the drug is well tolerated.

My doctor prescribed 1 mg titrated up to 2 mg over two weeks. I took my first dose tonight, so far the only side effect that I can discern is a massive headache, but to me I have those all the time. Acetaminophen took the headache away, so no problem. I will have to watch out for those over time.

This drug has made a world of difference to me in treating my PTSD. It helps with the major symptoms during the day and affords me a more restful sleep at night. I have been taking Prazosin for about six months now and have had my dosage raised to 6mg, 2mg in the day and up to 4mg at night. Depending on my sleep patterns, stress level and social situations I will either decrease or increase the dosage within the 6mg a day range as needed.

One issue I have experienced with this medication has to do with my memory. When I take the higher doses, I cannot for the life of me remember anything, including names of people I associate with on a daily basis. So, I weigh the costs when taking the larger doses. Am I overly stressed? Did I not sleep well the night before? Do I have to write a paper for school, or have an exam?

Another issue is the dream/wake state that you described. At times I will think I am dreaming when awake or have a memory that I cannot distinguish from a dream or the waking world. During such times I will remind myself and contribute the symptom to the medication and in doing so the episode expires.

Benzodiapinzes (Xanax, Valium, etc.) do not mix well with PTSD and should not be prescribed to treat PTSD. They can increase certain symptoms during the day, along with having powerful addictive properties.


Update: 1/15/2013 - I am still taking Prazosin, I am up to the maximum dosage for nightmares at 5mg. It still works today, still deal with the possibility of fainting but not as bad as when I first started taking it.

Fear of Remembering

A traumatized brain will construct defenses against remembering horrific memories, subdividing the mind into compartments, locking them away. When this has been done, emotions the most salient reminder of the traumatizing event, out of necessity will separate from the other five sensory memories. The bodily sensations, smells, images, taste, all of the senses recorded from environmental stimuli will also have been logged, but separated, wholly unrealized and dissociated from each other. Thus setting the stage for a never ending cycle of fear, avoidance, defenses and generating a transmutable spectrum of negative energy.

The recurring thought intrusions come to bear when the compartmentalized piece or pieces pierces through into our highly guarded and constructed reality. This incursion can be experienced as an all out assault on the person or a mildly disturbing and recurring thought.

Each of the compartmentalized parts represent unfinished or incomplete mental memory and energy, further complicating the survivors life. The split apart parts can have an energetic charge ranging from extremely low to explosively high. Fear of remembering, the "core phobia of traumatic memory" maintains a structurally dissociated memory imbued with a certain energetic level, which can manifest as a nervousness we naturally attach to defenses possibly giving rise to intrusive thoughts ranging from minor intrusions to acute dissociative flashbacks. In a flashback, for a moment all of the separated parts come together for an oppressive and harrowing reunion.

As the memories have not been fully realized and personalized can extrude into active recollection generating a unresolved alternate reality where the survivor relives the traumatizing event as it where happening again, in the here and now. Anger and rage can manifest from such an intrusion, but for the survivor this would be an inaccurate description of the palpable emotive infiltration. Much liked a flame attempting to escape from the grasp of its foundation, the survivor in a moment of dissociation extinguishes anger and rage as a fuel to fire a maladaptive defensive reflexive reaction.

Does the fire think about the source of the fuel firing the forge? The flames reach upward in a fervent and hopeless endeavor, a momentary expansion of bursting heated vapors channeling radiant energy in a quest of expending and consumption. The flame, having a preconditioned propensity for dissipation engages its primary purpose, a natural unrelenting predilection to push past all boundaries to maintain its periphery. There is only a surface connection felt by the survivor between the smoldering embers of the traumatizing event and the flame of raging emotions. Extreme defensive mechanisms upon engagement will now consume all rational thought and display its own surface charge blazing away until having been splayed and spent.

A Spiritual Experience, Piecing Together a Shattered MInd

If you are just now joining us and reading this post, I want to let you know that most of my writings here deal with combat PTSD. I have written about my childhood trauma a couple of times and want to update on where I am in therapy. Below I have put together some connections, associations and revelations. For someone without a traumatized mind some of these connections would seem to be an easy puzzle to put together, but for those of use who have survived, it is experinced as a spiritual experience putting together the pieces of our shattered minds.

Here I pick up from my post from March 17, 2009 "Thoughts of Nothingness We Now Find to be Everything":

Later, to defend against remembering an extreme trauma experience, I had convinced myself that aliens had replaced me, and took me with them to a better place. OH MY GOD, this must have been when I had the angels take me to explore the universe. I wrote earlier about this out of body experience, the angels told me to not look down. They were so peaceful, serene and angelic we soared above my body and escaped to a timeless existence flying away.

I never connected this phenomenon, the memories, beliefs, amnesia, and trauma. I had separated the information into the deepest recesses of my mind and compartmentalized them to guard against fully realizing the terror that little 5 year old boy endured.

I could not for the life of me learn my left from my right hand in first grade, I learned it when I was probably 7 years old. I was at a baseball game and my coach told me to go out to right field. I was ashamed that I did not know which direction right was, so I asked a family friend. He taught me to associate my right hand with my writing hand, so from then on I knew my left from my right. But, still to today I have to picture writing to discern which choice to make concerning left or right.

Another connection I made today was the problem I had with telling time. I did not learn this until I around the same time as the which hand issue. But, that was a digital clock, it was not until my young teen years before I learned to tell time from a traditional clock. I had such an unreconciled sense of time due to the "lost" time frame mentioned before, it lacked such substance that I did not trust "time," it escaped me.

I have had these thoughts periodically throughout my life, I guess when something triggered them and I would have a glimpse of a realization and memories. I never even considered connecting them together, it seemed to me that they were separate and not related. It was not until last night that I was able to piece together the memories and give a complete narrative. I did not see the obvious interrelation of these insights until last night.

I wrote this first on paper, in doing so I had written in third person conjugation and kept writing in this manner. I had to go back and edit it several times. Referring to oneself as him, they etcetera, etcetera, could be an indication of structural dissociation, an unconscious and pervasive referral of self as someone else. The thoughts of having been replaced with a "different Scott" is further evidence of the same.

I Write As I Am

Here in this blog I will be trying to relate to the public how a person navigates life with PTSD and how it interrelates to my everyday existence. If you disagree or do not understand, that is ok, sometimes I disagree and do not understand this arraignment within myself. The nature of structural dissociation of the personality leaves us with great conflicts within that can overwhelm our cognitive machinations and not only confuse others, and many times ourselves.

Many chronic sufferers have had childhood traumatizations, in the last two post I have been writing about my experiences and memories of such as it relates to my combat experiences. They have been muddled together and have not separated within the arraignment of my personality. Both have intertwined to wreck havoc in my today, as I have suppressed my past and now they find their way forward.

I write as I am, at times I find myself quite lucid and others not quite so. So if you find yourself confused, please ask for clarification and I will try and help you understand what I find to be confusing myself...

Deep Down Into The Marrow of my Morrow

I have been having these recurring thoughts about actually having to realize some honest to god awful truth about something that happened to me a long time ago. Before, it was just an intellectual exercise in something that I thought that had no bearing on me, other than some subconscious interaction that I knew nothing of. But now, I feel as if I am on the verge of remembering...and it scares the shit out of me. I cry at the drop of a hat, I do not want to remember...but, I do want to get past this...but I do not want to remember. When I feel intimacy and dip down into the essence of who I am, briefly I feel all that ever was, ever will be and ever has been. So too, especially after the feeling fleeting, floating away...I fell it until I fell no more...flowing away...I feel the sense of pending doom...a fear that resides deep down into my past, down into the mantle of my makeup, the marrow of my morrow.

I never knew that it affected me so, not until I felt that it made sense to go beyond. But, too do that I have to go through. I do not want to remember.

Who Develops PTSD from Combat

I received this comment at A Soldiers Perspective yesterday. My first reaction was to say, "What are you kidding me? Have you even read any of my posts?", along with a bunch of other really negative explicatives. But I had to back up and think about where this person was coming from, and some things my girlfriend has said to me. She told me that sometimes my writing is a bit obtuse (my words--yes a dense thick and hard to understand word to address exactly what she said about my writing, lol--I just love irony). I can get off into jargon and wordy wording of worldly...whatever.

So, anyway. I had to take a step back and realize that,

• one, my obtuseness can tend to be intolerable at times
  
• two the fact that I think from a practitioners perspective can further lead to speculation
  
• and finally, I have magical mystical thinking

which all could and maybe would be evidence that this guy might be on to something as far as someone making sense of what I write. Sooo, I had think about my message; to address the public and speak out about my life with PTSD and how that relates to my everything else.

His comment,

I really appreciate what you are trying to do for our fellow veterans. That said, I am not quite sure that I understand all of your writings. Are you saying that virtually all combat veterans will eventually get PTSD? There is no prevention. There is no cure. Furthermore, we need to hire someone to monitor all veterans for the rest of their lives to make sure that they don't commit criminal acts upon themselves or others in society?

My response,

I do not think that I said or implied any of what you suggest. An individuals reaction to any given trauma has a direct and indirect relation to their development, genetics, upbringing, environment, level of support, culture, level and number of traumatizations and a multitude of other considerations. Most trauma reactions will not lead to a pathological reaction. The implications of reactions to extreme stress have considerable ramifications to those of us who manage day to day with PTSD.

Structural Dissociation of the Personality

Relationship Between Dissociation and IdentityPersonal Attachments, Before and After Combat

Combat Attachments Born of Blood

Dissociative Spectrum

Do I think prevention is a viable cause? Yes, we can do much more to prevent PTSD than we do. Will this prevent everyone from getting PTSD? No, we train to drive a car. Does it prevent all accidents? No.

Fully Train Our Soldiers For the Rigors of War

As to whether a cure is to be had or found, that depends on the severity of the traumatization and the individuals response to it. Most with PTSD (simple PTSD) will become symptom free, others more chronically affected in all probability will not. Every person afflicted with PTSD can find considerable relief from major symptoms. Do I think that chronic, complex or combat PTSD can be cured? For most, no I do not. Do I think that we can find relief from major symptomology? Yes. I have had three years of extensive therapy (20 months in an in-treatment facility) and have resumed therapy again, with probably at least two to three more years to go.

None of the questions you pose brings an easy answer, if it did then we would not see the problems we see today. An attempt to fully answer your questions could be a dissertation topic, to say the least extremely time consuming and cumbersome. If you truly want to understand more, then read these articles. They address your questions,

Statistics, Effects and the Realities of Multiple Deployments

Combat Saturation

Experiencing PTSD

These articles tie together all the above,

Post Traumatic Stress Disorder: From A Combat Veterans Perspective

Dissociative Posttraumatic Stress Disorder and Influences on Criminality

Combat Veterans and Institutions: A Systems Analysis

Why a Combat Veteran or Soldier Does Not Have Patience

When a combat soldier or veteran exhibits little to no patience with family or society, he or she has been stripped of all the interpersonal intricacies that society thrives on. That which seems mundane and abhorrent to the combat veteran or soldier lubricates the interactions of civilization and serves to engage and breed closeness, familiarity and possibly the formation of trust by way of a gradual process of self-disclosure.

Through the proper revealing of information in a contextually rich environment; the person weighs the customs, personal values and boundaries against one another to assess whether or not they might seem compatible with others. If this seems so, then a person might incrementally reveal more of themselves after establishing a level of trust where common or shared revelations can lead to closer relations.

The Combat Values Theory I propose, has to do with a value structure that replaces or overrides our civilian values schema. They consist of primitive instinctual defensive mechanisms of survival and the disintegration of our inhibitions of taking a human life. Identity, cognitive dissonance, hindsight bias, attachment structures, memory and dissociation all have component features in trauma based disorders with evolutionary and cultural considerations. "The culture of combat veteran is formed by a shared experience, often traumatic and rooted in the work of soldiers" (Hobbs, 2008).

The combat veteran's or soldier's organization and structural dissociation of the personality has both defensive and survival motivated components governed by an "combat othering" internal values system. When a persons principles conflict with necessary actions to preserve life, the memories become encoded, an integral part of the combat self. The disconnection of idealized experiential meaning cordons off the memories and render them inaccessible to the conscious mind, but still influence unconsciousness through intrusive thoughts, emotions and sensory intrusions, due to the lack of integration leading to the structural dissociation personality. Decompressing and integration of compartmentalized memories could be the difference between a soldier or veteran becoming dissociative later.

Combat PTSD has its own sense of self, a survival system separate from the person and has a regulatory feature that intrudes upon the combat veteran or soldier relational interactions. An evolutionary defensive mechanism with purpose of get a person through survival situations and PTSD is like a button stuck on survival and when in combat or such, the person seems to be "normal" it is when they return from war that the problem becomes apparent.

The combat veteran's or soldier's value structure and sense of self have been fundamentally altered and do not match that of society. They have been conditioned to react to visual and auditory stimulus in the environment and to tune out that which poses no threat. Since societies interactions greatly differ from the combat zones, the combat veteran's or soldier's reality has been torn asunder by having been removed from the troop-organism. The closed circuitry of the troop-organism blocks out all attempts of interpersonal communication and interprets this function as an attempt to penetrate the boundaries of the now completely dysfunctional identity of the combat veteran or soldier.

Hobbs, K. (2008). Reflections on the culture of veterans. American Association of Occupational Health Nurses, 56(8), 337-341.

Combating a Simple Cure for PTSD

The other day I was tooling around the Internet and came across another website proclaiming to have found the"cure" for PTSD. That in three or four treatments they will be symptom free, ooo ooo ooo, and many in less! I just had to post a comment for people who would buy into this crap, to give some perspective on the misguided who may want to purchase this hopeless endeavor.

Below is the comment as I lay out a foundation and briefly discus the why and how's of chronic traumaitzation as it relates and conflicts with a possible "simple solution",

Cognitive-Behavioral Therapy (CBT) centers on skill building and the restructuring of the cognitive scaffolding that has been damaged by constant neurophysiological interactions mediated by the nervous system; the sympathetic, parasympathetic systems and regulated by the endocrine system (Clinician’s Guide to PTSD: A Cognitive-Behavioral Approach by Taylor, 2006).

In cases with extensive traumatization such as chronic childhood abuse of an interpersonal nature, results in complex trauma based disorders. The cognitive structure of the brain has not fully developed as it has been arrested by the violation of relational attachments vital to interpersonal relationships. Further, the forming of the personality stems from the interactions with others as we engage with others to find our identifications and identity (The Dissociative Mind by Howell, 2005, and The Haunted Self by Van der Hart, Nijenhuis and Steele, 2006).

I have done expensive research into the causes and treatments of trauma based disorders and have found that, no one treatment can cure chronic or complex traumatization. Simple trauma based disorders may be treated on a short term basis, and this “treatment” that you claim to have perfected and can “cure” PTSD, without an evidence-based credibility does nothing to add to cutting edge treatment modalities.

As noted in Van der Hart et al. (2006) the Theory of Structural Dissociation of the Personality (Lee, 2009) and the Phase-Oriented Treatment modality covers most of the symptomology and co-morbidity.

It will take years to integrate multiple traumatizations where the personality has been impeded developmentally and dissociatively compartmentalized.

Again I state that, no one treatment, can cure a chronically traumatized person of their maladies.

How Can They Understand That Unreality is My Reality?

In class on last Thursday, I met some resistance to the idea that chronic, complex or combat PTSD cannot be cured. The most recent and relative research concludes this finding and offers a series of treatments designed to give the person a more complete identity and sense of self. I understood their argument and based on the understanding of primary structural dissociation and simple PTSD, their rhetoric and argument would have merit. But, an expanded understanding on the nature of secondary and tertiary dissociation of the personality would reveal the underlying nature of multiple traumatizations and the shattering of an identity.

I hit a wall in trying to impart my experience from one who is mentally ill, with an educated perspective on that which I was speaking on. To say the least the futility I felt in that room that day was almost overwhelming. I started to get defensive and flustered with their repeated attempts to bolster their arguments and counter the information I was miserably failing to impart. They were trying to tell me that some people use their mental illness as a crutch, or an excuse.

They did not realize I was not trying to argue a point, but to give a perspective on what it was like for me to finally realize that others thought as I did, that shared my perceptions and I could identify with. I was attempting to verbalize my insights as it relates to the inner world of someone with a mental illness. I felt as if I was being attacked, that they were insinuating that I was the one trying to make excuses or make use of a crutch. I acquiesced on this point, yes I did make excuses and use this as a crutch when I was without a plan of recovery. I told them that recovery is a process, one cannot get from A to D, without first going through B and C.

That day was the day I fully realized that magnitude of the depth and permeation of the stigma attached to mental illness, gaining its teeth from this same attitude and limited "understanding."

How can I make others understand if a group of future Social Workers cannot get past their own biases and prejudgments? How can one who does not experience a world completely different from their own, accept my worldview? How can they understand that unreality is my reality?