Medication Safety Guide for Veterans Suffering From PTSD

Other conditions affecting veterans and other Americans every day include anxiety and depression. Data from the Anxiety and Depression Association of America (ADAA) shows that about 18% of U.S. residents experience an anxiety disorder in a given year. As for depression, the National Institute of Mental Health estimates that 7.1% of all U.S. adults had a major depressive episode in 2017, the most recent year for which statistics are available.

Medication for treating PTSD, anxiety and depression can help people live healthy, meaningful lives—if the medication is used safely. This guide outlines ways that medication can be safely used to treat these mental health conditions.

What Are PTSD, Anxiety and Depression?

PTSD, anxiety and depression are mental health disorders that have many possible causes, including genetic vulnerability, stress, traumatic experiences and medical problems. Chemicals inside and outside nerve cells are also involved. According to a Harvard Health Publishing article, there are “millions, even billions, of chemical reactions that make up the dynamic system that is responsible” for areas in the brain. The functionality of these chemicals in the brain can affect mood, cognitive abilities, perceptions and how a person experiences life.

Symptoms of PTSD, anxiety and depression can overlap significantly, according to Medical News Today. For example, someone with anxiety may show symptoms of depression, while someone with a depressive disorder may show signs of an anxiety disorder. These conditions are often comorbid, which means that they may appear together. Someone with PTSD may also have anxiety or depression. Symptoms and causes of the three conditions, along with the populations impacted, are discussed below.

PTSD

PTSD is a psychiatric disorder tied to traumatic events. Individuals with PTSD face interruptions in their present lives from disturbing thoughts and feelings related to past experiences.

• Common symptoms of PTSD are intrusive thoughts, including distressing memories and dreams of past traumatic experiences that feel vivid and present. Other symptoms include avoidance behaviors, distorted beliefs about oneself or others, and reactions such as excessive irritability and anger. PTSD may develop within hours or days after a traumatic event; in other cases, symptoms don’t surface for many years. Each veteran develops PTSD differently, but common traits include flashbacks, recurrent reminders and nightmares of traumatic events. For veterans, these intrusive, distressing thoughts can trigger emotional and physical reactions, including panic attacks and heart palpitations. Veterans with PTSD may have a persistent sense of danger, survivor’s guilt or shame associated with past events, which can diminish their ability to express positive emotions.
• Natural disasters and violent assaults are common causes of PTSD. Other causes may be indirect, like learning about a violent accident of a loved one or constant exposure to details of trauma experienced by other people, such as child abuse or murder cases. Combat situations are stressful and can contribute to PTSD in veterans. Politics surrounding a war, its location and the type of enemy faced can cause additional distress. Sexual assault can cause PTSD for people serving in the military and for veterans. Of veterans using VA health care, 23% of women reported sexual assault when in the military, 55% of women reported sexual harassment and 38% of men reported sexual harassment, according to VA data.
• Populations impacted. PTSD impacts veterans and people of any race, ethnicity, culture, age or gender. Women are more likely to get PTSD than men, according to the APA. Among the various forms of PTSD, disinhibited social engagement disorder and reactive attachment disorder occur most commonly in children, the APA reports.

The VA provides information about PTSD among veterans.

Anxiety

Anxiety is a persistent psychiatric disorder that impacts the quality of life for many people. Types of anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder, panic disorder and phobias.

• People experience symptoms of anxiety differently. Common symptoms include catastrophizing, paralyzing fear and obsessive-compulsive behaviors. Veterans with anxiety may feel their heart racing or have the compulsion to be on edge, looking over their shoulder. Uncertainty or new things can exacerbate symptoms of anxiety. The physical, emotional, and behavioral reactions and responses can reduce the enjoyment of life for veterans and others.
• Stressful events, including abuse, domestic violence and the death of a loved one, can cause anxiety. Anxiety disorders also run in families. Past traumatic experiences in combat or during military training can cause anxiety in veterans. The stress of transitioning to civilian life after years of service, job changes, and conflicts in relationships and family can exacerbate the condition in veterans.
• Populations impacted. People in every age group experience anxiety. Children and teens with anxiety may perform poorly in school or partake in risky behavior. Acute illness can cause anxiety in older adults. Anxiety disorders in veterans often originate in combat zones or military training. Anxiety may affect the ability of veterans to live productively as civilians.

Make the Connection, an online resource from the VA, provides more information about anxiety disorders in veterans. Healthline provides a resource with an extensive list of medicines and treatments used for anxiety.

Depression

Depression, a mood disorder that impacts thoughts and feelings, can create overwhelming sadness, loss of interest in life and lack of pleasure in activities.

• Common symptoms of depression include feelings of worthlessness, suicidal thoughts, noticeable changes in appetite, insomnia and cognitive difficulties. Veterans with PTSD are often also depressed. The symptoms of each condition sometimes overlap. Veterans returning from combat can have recurring thoughts of death or suicide. According to the VA, veterans are “ 1.5 times more likely to commit suicide than people who have never served in the military.”
• Causes of depression include faulty mood regulation in the brain, genetics, early losses in life, emotional trauma, stressful life experiences, medications and medical problems. The stress of warfare and adjusting to civilian life can cause depression in veterans. Some 76% of homeless veterans have an alcohol or a drug abuse issue, according to American Addiction Centers. Studies also show that traumatic brain injury, which creates physical scars on the brain, from war can be a factor in depression in veterans.
• Populations impacted. Depression affects every age group. Children and teens with depression may perform poorly in school, and older men may have thoughts of suicide, according to the Mayo Clinic. The average age for the onset of major depressive disorder, a form of depression, is 32.5 years, according to ADAA. Among homeless veterans, 28% have received a diagnosis of depression, reports American Addiction Centers.

Medication Safety Tips and Guidelines

The symptoms of PTSD, anxiety and depression are treatable in various ways, including two major types of medication: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Each type of medication treats certain disorders. However, mental health providers may prescribe medications as “off-label” treatments for a particular condition if they can justify their approach with established scientific research. According to Healthline, off-label refers to the use of a drug approved by the Food and Drug Administration (FDA) for a purpose for which the drug hasn’t been approved.

SSRIs

SSRIs can help reduce the symptoms of PTSD, anxiety disorders and depression. An SSRI works by blocking reabsorption of serotonin in key nerve cells in the brain. Serotonin is essential for learning and memory formation. It helps to regulate sleep, mood and appetite. The mood of a patient improves because of the increased availability of serotonin. SSRIs may help improve energy levels and reduce anxiety, unwanted thoughts and panic attack recurrence, among other symptoms. SSRIs have been proven in clinical studies to help restore the balance of serotonin in the brain of patients. Common SSRIs include:

• Disorders treated by Zoloft include PTSD, social anxiety disorder and depression. This medication comes in tablet, capsule or liquid form and is typically taken once daily, in the morning or evening. While in tablet or liquid form it can be taken with or without food, in capsule form, it should be swallowed whole with food, as prescribed by a doctor. Additional safety tips include using the proper medicine dropper to ensure the right dosage of the liquid. Sertraline is the generic name for Zoloft. Find more information on the uses, side effects and safety of Zoloft on WebMD.
• Disorders treated by Paxil include panic disorders, depression, obsessive-compulsive disorder (OCD), GAD, social anxiety disorder and PTSD. Within one or two weeks, patients may see improvements in their sleep patterns, energy level or appetite. These results may indicate that the medication is working. Improvements in depressed mood may take six to eight weeks. This medication comes in tablet, time-release capsule or liquid form. Safe use includes taking it once daily. Missing a dose of Paxil may result in a return of symptoms. Paroxetine is the generic name for Paxil. Details on the uses, side effects and safety of Paxil are available on the National Alliance on Mental Illness website.

For further comparison of Zoloft and Paxil, MedicineNet provides a resource. The APA also provides information on SSRIs.

SNRIs

SNRIs, often the first choice of physicians to treat major depressive disorder (MDD), are also used for GAD, panic disorder and social anxiety disorder. An SNRI works by both increasing serotonin and norepinephrine levels and by inhibiting their reabsorption into brain cells. This action increases the levels of active neurotransmitters. Norepinephrine contributes to attention, mental focus and memory.

Examples of SNRIs include Effexor, which is the first FDA-approved SNRI marketed in the U.S., as well as Cymbalta and Pristiq. American Addiction Centers provides a resource with more information on the types of SNRIs and their side effects and risks.

Additional Treatments and Helpful Tips

Each mental health disorder has unique characteristics. Medications do too. Other treatments not involving medicines can help, as well. For example, psychotherapy, also known as talk therapy, can be given alone or in combination with medicines.

A form of talk therapy known as cognitive behavior therapy (CBT) can help expose individuals to new ways of thinking. CBT teaches people to see issues from different perspectives and reframe negative thoughts about their trauma. Among the behavioral aims of this therapy is to provide a person with tools to cope better with triggers, react differently and feel less anxious. These tools can include a daily mood log that can help patients identify cognitive distortions—differences between what they’re thinking and what’s happening in reality.

Trauma-focused psychotherapies are highly recommended for veterans with PTSD, according to the VA. Together with a therapist, a patient sets goals and develops new skills. A therapy session can involve focusing on a specific memory or homing in on the meaning of a traumatic event that affects the patient. Through various techniques, such as visualization or talking and thinking through the event, veterans can learn how to process their traumatic experiences better and change unhelpful beliefs about themselves, others and the trauma event itself.

In addition to medication and therapy, activities that can help people with PTSD, anxiety and depression include:

• Being physically active can reduce stress and improve your well-being, according to ADAA. Exercise helps to produce endorphins, a type of neurotransmitter that can act as a pain reliever, enhance the quality of sleep and improve mood.
• Leveraging resources. One helpful resource is the Real Warriors Campaign, which provides guidance for active members in the military and veterans experiencing conditions such as PTSD, anxiety and depression.
• Social avoidance is a common symptom of mental health disorders. Often, however, recovery and health are achieved more easily in the company of others. Veterans are advised to take their time with reconnecting and to be patient—adjusting may take time.
• Practices such as mindful breathing, in which you focus your attention on your breath, is a stress management and meditation technique that can be helpful.
• Listening to soothing sounds. Loud noises and some aspects in an environment, such as smells and feels, often transport individuals with mental health disorders, particularly PTSD, back to a place of combat. Likewise, soothing sensory input can quickly relax you and send you to a place of calm. Experiment to find what sounds and environments work best for you—it could be a walk in the park or sitting on your favorite chair.
• Anger, irritability and moodiness are symptoms, and lack of sleep can make them worse. Ideally, try sleeping for seven to nine hours a night to rest your body and mind.
• Recognizing and coping. Frustration may come to bear during your transition. Still, the more you overcome the challenges, the more you increase your resilience.

Additional Medication Safety Tips

Here are some suggestions regarding medication safety for veterans suffering from PTSD, anxiety or depression.

• Verify prescriptions and dosage. Take medicines as prescribed, and be sure to take the right dosage. For example, a proper medicine dropper should be used to ensure the correct dosage of the liquid form of the medicine. Patients respond differently to medications; if you don’t see results, speak with your doctor before stopping any medication. Patients shouldn’t stop taking medicines when they feel better, either. Feeling better means the medicine is working. Missing a dosage may result in relapse and lead to withdrawal symptoms, such as nightmares, nausea, irritability or headaches.
• Identify issues and side effects. Side effects of both SSRIs and SNRIs include insomnia, sexual dysfunction, weight gain, upset stomach, headache and increased blood pressure. Abuse or misuse of these medications can lead to even more potentially dangerous side effects. Avoid alcohol and drugs, including nicotine, as these can interact negatively with medicines. These medicines may not be taken with other medicines, so check in with your doctor with a list of current medications you take to avoid the risk of relapse or worse. Taking drugs and alcohol to numb painful memories can result in substance abuse, which can worsen PTSD, anxiety disorders and depression.
• Communicate openly with health practitioners. Individuals with PTSD, anxiety disorders and depression tend to feel disconnected from others or withdraw from social activities. However, it’s essential to stay connected and communicate openly with others. Reaching out to someone who won’t judge, criticize or get distracted—a family member, friend or therapist—is critical. Recovery is much easier with the guidance of an experienced doctor or therapist. Seek out professional help right away and communicate openly with a health practitioner about your feelings, thoughts and concerns. The more information you provide, the better they can help you with treating symptoms.

Big Data’s Role In Helping Veterans

Technology innovation is helping to solve one of the biggest challenges of PTSD: identifying at-risk patients shortly after a traumatic event. In one study, published by JMIR Mental Health, the use of computational analysis methods and machine learning models showed that “accurate predictions can be made 10 to 20 days posttrauma,” which means that at-risk patients could be identified for early intervention.

Similarly, the VA is leveraging predictive modeling, health care informatics, big data and artificial intelligence (AI) to provide resources for veterans and their health care providers. For example, the VA’s REACH VET program (Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment) uses AI to identify veterans who are at high risk for suicide. The system scans medical records and looks for signs of mental health. Upon identifying at-risk veterans, a mental health specialist can connect with them, assess their well-being, and review and personalize their treatment plans as needed.

Additional Resources:

American Psychological Association, Medications for PTSD

American Psychiatric Association, What Are Anxiety Disorders?Anxiety and Depression Association of America, Medication

Harvard Health Publishing, What Are the Real Risks of Antidepressants?

Healthline, What Are the Causes and Risk Factors for Generalized Anxiety Disorder?

HelpGuide, “Post-Traumatic Stress Disorder (PTSD)”

HelpGuide, “PTSD in Military Veterans”

Mayo Clinic, Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

National Alliance on Mental Illness, Veterans & Active DutyU.S. Department of Veterans Affairs, PTSD: National Center for PTSD