Introduction
Post-traumatic stress disorder (PTSD) is a psychiatric illness caused by undergoing or witnessing a distressing event and difficulty healing from experience. PTSD changes the cognitive and psychosocial habits of an individual. Symptoms include episodes of depressive mood, increased sensory and motor activity, insomnia, avoiding pleasurable activities and circumstances, or locations that trigger the trauma they experienced. The illness is manageable with proper medication along with recommended psychotherapy. The paper discusses the treatment of PTSD and the pharmacokinetics of various antidepressants such as fluoxetine, citalopram, paroxetine, and sertraline.
PTSD Treatment
PTSD is treated with antidepressants such as sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), and fluoxetine (Prozac), among others. Research according to Grunebaum et al. (2018) indicates that citalopram use is associated with rapid symptom reduction than other antidepressants, and therefore it is described as the starting point for the treatment of depression. However, drug responsiveness and efficacy depend on factors such as age, ethnicity, and the presence or absence of cytochromes (CPY450) enzymes. The drug is also known for its efficacy over the years and the fewer side effects than in other antidepressants. Citalopram is an antidepressant of the Selective-Serotonin Inhibitors (SSRIs) drug class, also called an antagonist antidepressant (Shoar et al., 2020). The treatment is more effective in improving patient welfare; thus, it is approved by the United States Food and Drug Administration (U.S FDA) for managing PTSD and other mental illnesses.
The benefits of using citalopram in treating PTSD involve its ability to alter brain chemicals responsible for the change in behavior, thus becoming more effective in managing mental health disorders. SSRIs adjust the amount of serotonin in the brain. The serotonin hormone is the chemical responsible for mood regulation in the body. It is also responsible for eating and sleeping patterns. Other hormones that bring a feel-good effect are dopamine, endorphins, and oxytocin. Meanwhile, alteration of the chemical levels causes imbalance and thus abnormality in the psychomotor and behavioral control (Shoar et al., 2020). SSRIs treat PTSD by balancing the hormone bringing about calmness by hindering serotonin absorption. Furthermore, a good mood improves the patient’s self-worth and thought processes and eventually copes with the traumatic event and increased stress. Consequently, the limitation of using citalopram in treating PTSD includes increased suicidal thoughts, increasing the chances of patients harming themselves. Suicidal thoughts come from agitation and irritability, causing an individual to become easily frustrated or upset in the presence of PTSD triggers. Similarly, patients indicate a change in behavior, an individual using citalopram develops withdrawal symptoms and becomes less active while interacting with others.
Pharmacokinetics of Citalopram
In addition, the neurons responsible for stress stimulation are the dopamine neurons in the mesocortical structure of the brain. Dopamine in the prefrontal cortex increase in reply to the perceived pressure. Consequently, the noradrenaline hormone in the various brain parts is triggered by severe stressful impulses, increasing its concentration in the prefrontal cortex (Kanherkar et al., 2018). SSRIs work by elevating serotonergic neurotransmission by inhibiting the reuptake of the serotonin neurotransmitter 5-hydroxytryptamine (5-HT) (Kanherkar et al., 2018). The serotonin reuptake inhibition increases its concentration and stimulates the neurotransmitter’s postsynaptic receptors, which causes a desirable mood. As a result, the therapeutic effects of citalopram affect the patient after long-term use of the medication.
Citalopram dosage should be gradually lowered to avoid the withdrawal symptoms such as dizziness, sweating, nausea, tingling in the feet and arms, or irritability. The significance of using the medications is their effectiveness in reducing depressive mood periods, anxiety, paranoia, and suicidal thoughts (Ruhe et al., 2019). However, the most common aftermath of the treatment involves dizziness and gastrointestinal disturbances. The adverse side effects for immediate medical attention are cases of hallucinations, trouble swallowing, breathing difficulty, weight gain in adults, and low sexual urges. It causes heavy menstrual flow in females, erectile dysfunction in males’ reduced appetite, and weight loss in children.
Other warnings given for citalopram are; a lower dosage for geriatric patients with a maximum dosage of twenty milligrams per day. Normal patients should be prescribed at most forty milligrams per day to minimize tachycardia and other life-threatening reactions. (Prescribers’ Digital Reference, n.d). Besides, medication efficacy depends on the patient’s adherence to the treatment. Psychiatric patients should have caregivers or family members to help with drug compliance, closely monitor their progress, and report cases of significant drug reactions.
Patients in modern society have complete control over their well-being more than health care specialists. They may have more information from the internet concerning the medication, and they have the right to decide the type of treatment they should take (Yilmaz & Gokmen, 2020). On the contrary, psychiatrists are responsible for informing the patients of the drug benefits and side effects but should not breach the patient’s autonomy. It is also legal and ethical for psychiatrists to observe the confidentiality of the patients of information (Yilmaz & Gokmen, 2020). Coercion is another applicable principle when dealing with PTSD patients because they are at risk of suicidal contemplations, and therefore, the family should be compelled to take part in their care.
Psychotherapy is recommended as the first management strategy for mental issues, upon which the psychotherapist will refer the patient for further clinical assessment and treatment. Cognitive-behavioral therapy helps avert other unwanted symptoms such as gastrointestinal disturbances, organ complications, toxicity, weight gain, or loss as a result of medications taken (Yilmaz & Gokmen, 2020). Dietary changes should be incorporated into the treatment to enhance mood. Research shows that some foods, such as eggs, nuts, and pineapples, among other fruits, increase the serotonin levels in the brain (Yilmaz & Gokmen, 2020). Therefore, physical exercises to avail much too triggering the serotonin hormone.
Conclusion
On the other hand, psychiatric illnesses affect all ages and have great socioeconomic impacts; as a result, it leads to lower productivity, job losses, and poor social relationships. High mortality rates due to mental issues are still rampant worldwide; hence, research has been done on the treatment and prevention of the disorders, but there is still a chance for more advancements. Therefore, the government and health urgencies should encourage and provide incentives to support further research.
References
Grunebaum, M. F., Galfalvy, H. C., Choo, T. H., Keilp, J. G., Moitra, V. K., Parris, M. S.,… & Mann, J. J. (2018). Ketamine for rapid reduction of suicidal thoughts in major depression: a Midazolam-Controlled Randomized Clinical Trial. American Journal of Psychiatry, 175(4), 327-335. Web.
Kanherkar, R. R., Getachew, B., Ben-Sheetrit, J., Varma, S., Heinbockel, T., Tizabi, Y., & Csoka, A. B. (2018). The Effect of Citalopram on Genome-Wide DNA Methylation of Human Cells. International Journal of Genomics. Web.
Ruhe, H. G., Horikx, A., van Avendonk, M. J., Groeneweg, B. F., & Woutersen-Koch, H. (2019). Tapering of SSRI Treatment to Mitigate Withdrawal Symptoms. The Lancet Psychiatry, 6(7), 561-562. Web.
Prescribers’ Digital Reference, (n.d). FDA Drug Safety Communication. Web.
Shoar, N. S., Fariba, K., & Padhy, R. K. (2020). Citalopram. StatPearls Publishing. Web.
Yılmaz, C., & Gökmen, V. (2020). Neuroactive compounds in foods: Occurrence, Mechanism, and Potential Health Effects. Food Research International, 128, 108744. Web.