June 24, 2010

Medications for a Combat Veterans Treatment of PTSD

One pill makes you larger

And one pill makes you small,

And the ones that mother gives you

Don't do anything at all.

-White Rabbit, Jefferson Airplane 1967

I awoke this morning with a list of items I needed to tackle today. The real trick for me is trying to balance all my work around my family and husband. Today's list consists of running to the post office to mail off many candles, make some phone calls for FRG and our upcoming Family Day, write an article for our unit newsletter, and get my husband's medications in order. So armed with my extra large cup of coffee and my Vietnam Era music playing in the background, I hit the ground running. I had to buy my husband one of those seven day a week pill reminder boxes, or as we lovingly refer to it as, the Old Man Pill Box. Once a week I must refill it for twice to three times a day, and then double check myself as I can be forgetful sometimes. Once completed, I must then go through and double check all the original bottles they came in just to make sure he has plenty in supply or begin the refill process. I wondered how many others are on the same meds and what do all these do for my husband? Thought the White Rabbit song reference really played well with my blog this morning!

  • Citalpram - (Commonly known as Celexa, Cipramil) Anti-depressant used to treat major depression, social anxiety disorder, panic disorder and OCD. My husband takes 40mg twice a day. Side effects: fatigue, drowsiness, dry mouth, increased sweating (hyperhidrosis), trembling, headache, dizziness, excessive yawning, sleep disturbances, insomnia, cardiac arrhythmia, bruxism, hallucinations, blood pressure changes, nausea and/or vomiting, diarrhea, heightened anorgasmia in females, impotence and ejaculatory problems in males. In rare cases (around over 1% of cases), some allergic reactions, convulsions, mood swings, anxiety and confusion have been reported. Also sedation may be present during treatment of citalopram. I can vouch for the sweating, headaches (which has worsened because he has TBI in which he also suffers headaches from), Impotence, and the rest? Well, where does one begin and separate from PTSD symptoms he already suffered from? This is the primary cause of impotence in Veteran's or so we were told by his physician. Her take was be crazy, or no sex...."I'll take No Sex Life Alex, for 500".
  • Magnesium Dietary Mineral - Taken at 400 mg per day, this was prescribed by his primary care physician, who is really really into holistic medicine practices, if you remember my past reference to her with the fish oils and vitamins to make him poop. Now supposedly, this is to help with his headaches. If it does, I can't tell. It is "being investigated" for the treatment of migraine headaches.
  • Ativan - Commonly known as Lorazepam (We call it the crazy pill). My husband has to take 0.5 three times a day, and then two more at night. It is used for the management of anxiety disorders, the short-term relief of symptoms of anxiety or anxiety associated with depression. The effectiveness of lorazepam and other benzodiazepines has not been adequately studied for treatment beyond 4 months. (nice as my husband has been taking this for three years now) Lorazepam can cause physical dependence (even better). The most common side effects associated with lorazepam are sedation, dizziness, weakness, and unsteadiness. Other side effects include a feeling of depression, loss of orientation, headache, and sleep disturbance. Now the thing that disturbs me, is he already had depression and headaches. So they give him this one, which causes more depression and more headaches. Kind of fighting a losing battle here between medications
  • Trazadone - AKA Zombie Maker. 100 mg at night. It is another anti-depressant used to treat Panic Disorders, Diabetic Neuropathy, Bulimia, OCD, Alcohol Withdrawal, Schizophrenia, other psychoses and Complex Regional Pain Syndrome. Last but not least, Control of nightmares or other sleep disturbances. The most common adverse reactions encountered are drowsiness, nausea/vomiting, headache and dry mouth. (Here we go again with the headaches) Now this is the medicine he takes at night for nightmares, sleepwalking, and night terrors. This is literally a zombie maker as the world could blow up around him and he would sleep right through it. The only problem I have with this medicine is that it leaves him groggy and irritable the rest of the day but does knock him out and we can all rest.
  • Gabapentin - Also known as Neurontin. This is taken 3 times a day at 300mg. It was originally developed for the treatment of epilepsy, and currently, Gabapentin is widely used to relieve pain, especially neuropathic pain. This was prescribed for my husband's back and knee pain which is leftover from injuries which occurred from an IED explosion in Iraq. Gabapentin is widely believed to help patients with post-operative chronic pain. So far, we haven't seen any difference in him on this medication. Most common side effects in adult patients include dizziness, drowsiness, and (swelling of extremities); these mainly occur at higher doses, in the elderly. Also, children 3–12 years of age were observed to be susceptible to mild-to-moderate mood swings, hostility, concentration problems, and hyperactivity.
  • Tylenol with Codeine - Prescribed 1-2 tablets every four hours for severe pain. He doesn't take this one every day but only on a need to need basis. This is for pain he feels in his lower back, both knees and for severe migraine headaches.
  • Omeprazole - Commonly known as Prilosec and prescribed to my husband for gastric/stomach problems such as severe heartburn and indigestion which has been causes from all the other medications. Taken at 20mg twice a day. Hell, if I had to take this much, I would have stomach problems too!
  • Tizanidine - Commonly known as Zanaflex. Prescribed to my husband for severe muscular spasms. As need basis, he takes 4 mg (2 tabs) three times a day. It is used to treat the spasms, cramping, and tightness of muscles caused by medical problems such as multiple sclerosis, spastic diplegia, back pain, or certain other injuries to the spine or central nervous system. It is also prescribed off-label for migraine headaches, as a sleep aid, and as an anticonvulsant. It is also prescribed for some symptoms of fibromyalgia. This one really knocks him on his butt too.
So which one is best for him, and which one makes him worse? I look over all these and an overwhelming sadness fills me. My husband was one who never took anything! I think in the past ten years, I can remember him being sick once. His cure for the common cold was hot tea with a shot of moonshine (hey, we are from Tennessee-Moonshine cures all that ails ya!). Occasionally he might get a headache and I would literally have to force some tylenol or Goody's powder down him! Who would have thought my husband, after war, would come home and require so much maintenance and medications! Now as we are awaiting his appointment for the TBI doctor (Traumatic Brain Injury), I am curious to see if they will add yet another pill to his repertoire of many. I can't really complain as his mood, his anger, and triggered episodes are a lot more dulled, but in the same sense he is a walking zombie all the time. This has caused our sex life to disappear, makes him sleep hard and for long hours at a time, and his mood more irritable (although more tolerable with the meds). Is there really ever going to be a happy medium in PTSD?


  1. Good post, I take some of these and will add what I know of them:

    Gabapentin-it does work for pain management, but not in the doses you are taking (900mg). I take 3200mg a day, 2-400mg capsules twice a day and four at night.

    I stopped taking 4 antidepressants about 2 months ago, hence all the crying lately...but years after the fact I have been able to wean myself off of the medications your husband takes. I have taken most of them, I took benzodiazepines for years.

    A medication that was not mentioned and this is my biggest one I love to take.

    Prazosin-a blood pressure medicine, the side effects are marked decrease in nightmares, and works to effect the major symptoms of Combat PTSD. It cuts down the hyper responses and allows the combat vet to put down his or her guard.

    Today I take Gabapentin (3200mg), Prazosin (4mg), hydroxyzine (125mg), omeprazole (40mg), trazodone (100mg) and arthritis strength Tylenol (5200mg) daily. I probably need to go to a stronger pain medicine so I can cut down on the amount of Tylenol I'm taking. But to do that I would need to take a narcotic, and they offer it to me all the time.

  2. How does the Prazosin help with your sleeping? I would LOVE to get him switched off the trazadone.

  3. Scott,
    Does the prazosin help keep you from dreaming? That is what my psychiratrist said. It inhibits those nasty hormones while you are sleeping so you do not have a stress reaction.

    I was taking Zoloft, it worked for a while, but had a lot of sexual side effects(which was fine with me but I was married to someone at the time who was neurotic about me having an orgasm). However it did not help with my dissassociative periods and almost made it easy to slip into them. When I would stop taking it, I would go into a weird manic state. I wish I could go into detail...but some of the things I did bring me alot of shame and distress.

    I was on Celexa, which was okay. It go rid of the PTSD fog, and helped with motivation. I am off of it now(hubby wants a baby). I picked up some holistic hobbies, hired on a lifecoach$$$.As soon as that kid drops...back on the meds!

  4. Not for me, I dream every night. Before I started taking Prazosin I had nightmares about every night for 2o years. As soon as one day after taking this medicine I started having vivid dreams that I remember and found joy in. I think that your doctor is talking about the reason they stopped giving it to anyone for high blood pressure due to the side effect of flat affect. For Combat PTSD we are so hyper that this medicine only takes the edge off of the major symptoms of PTSD, especially nightmares.

    This is a miracle drug for me (http://www.huffingtonpost.com/scott-mendelson-md/president-obama-end-the-n_b_566343.html), the side effects are why I take it, not something I put up with because I am told I need it the rest of my life. I gained 70 lbs taking Prozac and three other meds for depression. PTSD is not depression, it does have every symptom of depression, but it is not what is wrong with the Combat Veteran. We are not depressed because of our experience, we are overloaded with our experiences and it exhibits itself as depression, when in reality we are just stuck between on and off.

    I used to take four antidepressants, but wanted to kill myself all then time and could not feel anything other than depressed. Two months ago I stop taking them and experience the most transformative time in my life. I am beginning to think that antidepressants are dangerous for our combat vets due to the psychotic/dissociative symptoms that become compounded by the permanent use of a temporary fix; antidepressants.

    I only advocate for antidepressants temporarily while taking CBT therapy, values, communication, social and life skills training and personal counseling. Along with ABC's of Combat Stress Reactions and how they can become debilitating mental wounds if left untended. Then we need to give them the support to make them productive again, no matter how long it takes.

    I was on antidepressants for 2o years on and off and have never received therapy for Combat...I may have to go outside the VA to get the latest in trauma care. All this research is on my site here somewhere.

    Copy and paste what you find here, thanks.

  5. The hallucinogenic effects of drugs, in the most widely accepted among scientists, show that the effects of these types of drugs help advance the therapeutic process and shorten therapy usage and improved success for longer periods of time...MDMA, THC and LSD have all been proven to have healing properties when administered by a clinical practitioner under controlled settings for trauma therapy.


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