Hope for Stress Disorders: Current therapies and things to watch for

My last few posts have focused on stress/anxiety disorders. It's hard to cover the neuroscience behind these complex disorders in just a few posts, because there are so many changes going on and so many angles from which one can approach them in the first place. I didn't even get into the neuroendocrine stuff, because that is probably 2 posts on its own. Suffice to say, the short-term changes that manage to keep someone going through a tremendously stressful event don't always snap back to day-to-day life so easily. Sometimes intervention is required. ASD has the potential to progress to PTSD if not treated. PTSD can be a chronic, debilitating condition.

FDA-approved drugs

Sadly, we haven't found many effective drugs to help with stress disorders. I think the neuropharmacology research world has a long road to travel on this end of things. The two approved drugs are paroxetine and sertraline- both SSRIs, or selective serotonin reuptake inhibitors. They work by prolonging the time that the neurotransmitter serotonin stays in synapses. You may have heard of their common use for depression. Though there are depressive-like elements to PTSD, these are two quite distinct disorders. However, they may share some common mechanisms in the brain that make SSRIs potentially useful in both cases. But SSRIs do not work for everyone.

Off-label use

There are a handful of drugs that are used off-label as well. These drugs haven't been approved by the FDA specifically for PTSD, but have been approved for another use that may be related to stress disorder symptoms. Sleep aids (zolpidem and eszopiclone are two examples) work by increasing inhibitory tone in the brain. Adrenergic antagonists like propranolol work to blunt the sympathetic "flight or fight" response. They block adrenergic receptors, so when the body produces a lot of epinephrine (adrenaline) the stress response is reduced. They might be useful in reducing the constant vigilance. Several of these off-label drugs are in clinical trials specifically for use in PTSD.

Non-drug therapy

There are therapies available that do not make use of drugs, however, they can be used in combination with a drug treatment regimen. Two types of cognitive-behavioral therapy so far seem to help make progress: prolonged exposure therapy and cognitive-processing therapy.

Current studies

Many clinical studies are underway for new potential therapies to assist with PTSD. These include pharmacological and non-pharmacological approaches. A few of the more interesting ones are:

• Modified CBT therapies including virtual reality
• Extinction learning enhancers such as d-cycloserine
• Controversial compounds such as THC and MDMA
• Anticonvulsants such as topiramate
• Stress hormone modulators such as hydrocortisone

For more resources, I highly recommend checking out the National Center for PTSD's webpage. And as always, if you feel that you might require medical attention, please do not seek help from blogs or other internet sources, but see your doctor for appropriate medical evaluations.