Biological Theories
John’s symptoms meet the criteria for a post-traumatic stress disorder (PTSD) diagnosis. One etiological theory is that neurotransmitter-mediated behavioral changes occur where decreased dopamine and serotonin induce exaggerated noradrenergic activity in subsequent exposures after initial shock causes neurotransmitter depletion (Wright et al., 2019). Another etiological model is that traumatic events damage neural pathways and the PTSD symptoms are the effects of the resulting cortical changes.
Best Theory
Between the two etiological models mentioned above, the second one provides the best etiological explanation for PTSD symptomatology. Intense sensitization of interrelated neural-synaptic structures induced by a trauma results in temporary or permanent impairment of the neural system (Wright et al., 2019). Due to cortical connections, perceptual and cognitive domains are also affected by the initial traumatic event, leading to symptoms such as recurrent flashbacks.
Pharmacological Treatments
Approved medications can help treat PTSD symptoms and improve patient outcomes. SSRIs, such as sertraline, have been shown to reduce anxiety and increase concentration. Prazosin is another anti-anxiety medication approved for treating PTSD symptoms (Wright et al., 2019). It can help suppress trauma-related nightmares or intrusive flashbacks in survivors. It is an alpha-blocker that treats distressing symptoms of PTSD and decreases noradrenergic activity in patients.
Mechanism of Action
Sertraline is an antidepressant drug that belongs to the SSRI category. It inhibits presynaptic serotonin reuptake, causing a buildup of the neurochemical. Serotonin is involved in mood regulation, and therefore, inhibiting its reuptake improves PTSD symptoms (Wright et al., 2019). Prazosin is an alpha-adrenergic blocker that lowers stress responses in cortical regions. These inhibitory effects help improve sleep and decrease nightmares experienced by PTSD patients.
Possible Side Effects
A common adverse effect of sertraline is a high risk of bleeding due to its inhibitory effects on blood clotting. Like other SSRIs, the drug can also cause diarrhea, vomiting, confusion, hallucinations, and sometimes suicidal ideation (Wright et al., 2019). Dizziness is a common hypotensive side effect associated with prazosin use. Some patients may also experience edema and palpitations but negative behavioral symptoms are rare.
Possible Interactions and Contraindications
Sertraline interacts with other medications, which increases the intensity of side effects. Adverse interactions with pimozide, monoamine oxidase inhibitors, and NSAIDs that include blood thinners (Wright et al., 2019). Sertraline is contraindicated for people with hemophillia (because of a high bleeding risk), manic behavior, and suicidal thoughts. In contrast, for prazosin, risk-benefit considerations should be made for patients with cardiac disease, angina pectoris, and renal dysfunction.
References
Wright, A. L., Sijbrandij, M., Sinnerton, R., Lewis, C., Roberts, N. P., & Bisson, J. I. (2019). Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: A systematic review and meta-analysis. Translational Psychiatry, 9 334.