Post-traumatic Stress Disorder (PTSD): emerging strategies for prevention and treatment

PTSD in overview
PTSD is a severe anxiety disorder that occurs following direct or indirect exposure to trauma. In cases of direct exposure to trauma symptoms of PTSD develop after a potentially life-threatening situation such as a serious injury, physical assault or threat of assault, torture or rape. PTSD may also result from indirect exposure to trauma such as ‘witnessing’ events that threaten the lives of others but do not directly affect the observer, or learning about a life-threatening event (especially one that affected a family member or friend). Symptoms of PTSD may begin within days following exposure to trauma or onset may be ‘delayed’ months or years. Symptoms of psychic numbing typically start immediately following exposure to trauma. Other symptoms that more often emerge in the days and weeks following trauma include repetitive intrusive memories of the traumatic experience (flashbacks), autonomic arousal (perspiration, rapid breathing, elevated heart rate), recurring nightmares, and hyper-vigilance. Traumatized individuals actively avoid situations that remind them of the traumatic event, may have amnesia of the traumatic event, and often experience profound feelings of detachment and loss.

Depressed mood, anxiety, anger, intense shame or guilt feelings, distractibility, irritability, and an exaggerated startle response may continue for years following exposure to trauma. Severely traumatized individuals may experience psychotic symptoms including dissociative symptoms (e.g. difficulty perceiving their body or the environment as ‘real’), and auditory or visual hallucinations. Traumatized individuals may be severely impaired by their symptoms and unable to function at work, in school, in relationships or other social contexts. The majority of individuals diagnosed with PTSD have at least one other serious mental health problem such as generalized anxiety disorder, panic disorder, phobic disorders, major depressive disorder, obsessive-compulsive disorder, anti-social personality disorder, and alcohol or drug abuse. Acute Stress Disorder (ASD) is a less severe variant of PTSD in which all symptoms resolve within one month following exposure to trauma. Roughly one half of individuals who are diagnosed with ASD eventually develop full-blown PTSD.

The enormous personal, social and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to PTSD are major issues facing American society at this time because of the military conflicts in the Middle East. As many as one half of all persons diagnosed with PTSD who are treated with prescription medications or conventional psychological therapies do not fully respond. PTSD resulting from violent assault, rape or traumatic exposure to combat is often characterized by severe symptoms that are poorly response to treatment.

Conventional treatments of PTSD and their limitations
Conventional pharmacologic and psychological approaches widely used to treat PTSD are based on the assumption that traumatic exposure results in chronic dysregulation in neurophysiology and maladaptive coping with stressful situations. Pharmacological and psychological therapies endorsed by mainstream psychiatry reduce the severity of some PTSD symptoms however most conventional approaches have limited efficacy. In addition to problems associated with limited efficacy many medications cause significant adverse effects resulting in poor adherence or treatment discontinuation. For example the long-term management of PTSD with SSRIs or other conventional drugs frequently results in weight gain, sexual dysfunction and disturbed sleep. The limitations of current mainstream approaches invite open-minded consideration of the range of promising alternative and integrative approaches aimed at preventing PTSD following exposure to trauma and treating chronic PTSD.

Non-medication approaches used to prevent or treat PTSD
The limited effectiveness of available mainstream treatments of PTSD invites serious consideration of non-medication approaches. Natural supplements used to prevent PTSD (i.e. before or after exposure to trauma) or treat chonic PTSD include dehydroepiandrosterone (DHEA), omega-3 essential fatty acids and a proprietary micro-nutrient formula. While most natural supplements are safe when a quality brand is used at the recommended dosage, some herbals and other supplements may have serious adverse effects when taken at inappropriate high dosages or in combination with prescription medications. Other non-medication approaches that can be used to prevent or treat PTSD include massage, dance/movement therapy, yoga, meditation and mindfulness training, virtual reality exposure therapy (VRET) and EEG biofeedback training.

Mindfulness training may reduce symptoms of PTSD when improved attention permits increased control over intrusive thoughts or memories. Patients who engage in a mindfulness practice can be trained to shift attention from remembered fears to present-focused problem solving permitting improved coping. The therapeutic benefits of mantra meditation are believed to be related to the effects of repetitive chanting on reducing the overall level of arousal permitting improved emotional self-regulation. Important advantages of meditation in the treatment of PTSD include ease of training, low cost and practical implementation in group settings.

If you are struggling with post-traumatic stress disorder (PTSD) and taking a medication that isn’t decreasing your symptoms, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working you may benefit from my book Post-traumatic stress disorder: The Integrative Mental Health Solution—safe, effective and affordable non-medication treatments of PTSD. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Post-traumatic stress disorder (PTSD): The Integrative Mental Health Solution will help you
• Understand PTSD better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for preventing or treating PTSD
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book on Amazon.com

Bipolar disorder: managing your symptoms from an integrative perspective

Bipolar disorder in overview
Approximately 1% of the adult population experiences persisting mood swings and fulfills criteria for the diagnosis of bipolar disorder. Bipolar disorder is a heritable mental illness. First-degree relatives of Bipolar individuals are much more likely to develop the disorder than the population at large. Bipolar illness in one identical twin corresponds to a 70% risk that the other twin will also have the disorder. This risk is estimated at 15% in non-identical twins. Recurrent episodes of mania are often associated with progressive deterioration in social and occupational functioning, and often lead to job loss and divorce. Approximately two thirds of individuals diagnosed with bipolar disorder are unemployed, although most have attended college. One fourth of Bipolar I patients attempt suicide, and 15% eventually succeed.

A diagnosis of bipolar disorder is made after an individual experiences at least one episode of mania. Mania is a symptom pattern that lasts several days or longer and consists of emotional, behavioral or cognitive symptoms including rapid speech, racing thoughts, euphoric or irritable mood, agitation, inflated self-esteem, distractibility, excessive or inappropriate involvement in pleasurable activities and diminished need for sleep. Symptoms of psychosis such as hearing voices, paranoia or delusional beliefs, may occur during episodes of severe mania or depression. A manic episode causes significant impairment in one’s ability to work, go to school or be in a relationship. In contrast ‘hypomania’ is a milder form of mania characterized by less severe symptoms that is shorter in duration. The majority of individuals diagnosed with bipolar disorder experience episodes of depressed mood more often than mania or hypomania.

Many individuals diagnosed with bipolar disorder also have problems with alcohol or drug abuse, which they may use to ‘self-medicate’ mood swings. Chronic alcohol or drug abuse can also cause erratic changes in mood that resemble the mood swings seen in bipolar disorder. Medical problems that can cause mood swings similar to the symptoms of bipolar disorder include thyroid disease, multiple sclerosis, and strokes affecting certain brain regions.

Limitations of conventional treatments
Prescription medications used to treat bipolar disorder include so-called ‘mood stabilizers’ such as lithium carbonate and divalproex; antidepressants; antipsychotics; and sedative-hypnotics. Unfortunately, currently available prescription medications used to treat both the depressive and manic phases of bipolar disorder have only limited effectiveness. This is due in part to a high rate of non-compliance with conventional pharmacological treatments among many bipolar patients, and due in part to limited efficacy of medications themselves. It is estimated that less than one third of all individuals who meet criteria for bipolar disorder receive any treatment for manic or depressive symptoms during the active phase of their illness. Because less severe symptoms of mania (i.e. ‘hypomania’) often go unreported, and because many symptoms of hypomania resemble agitation or anxiety, there is on-going debate over the rate of occurrence of bipolar disorder compared to major depressive disorder. Only half of currently available prescription medications used to treat bipolar mood symptoms are based on strong research evidence of efficacy. Fewer than half of individuals who take conventional maintenance treatments for bipolar disorder following an initial manic episode experience sustained control of their symptoms. Further, the relapse rate among bipolar patients who adhere to lithium carbonate or other conventional mood stabilizers is also very high at approximately 40%. Finally, the use of prescription antidepressants does not reduce the frequency of depressive symptoms in bipolar patients over the long term nor does it lead to increased time spent in remission.

As many as one half of patients who are treated for Bipolar disorder fail to adhere to their recommended regimens of conventional mood stabilizers, often because of adverse effects. Bipolar patients who discontinue lithium carbonate or other conventional mood stabilizers are almost certain to relapse. There is evidence that discontinuation of lithium carbonate, and other prescription medications, is associated with reduced efficacy if these medications are resumed in the future. A review of 7 studies (4 of which were randomized) involving 358 patients concluded that adding an antidepressant to lithium therapy does not substantially increase protection against bipolar depressive recurrences.

Non-medication treatments of bipolar disorder
The limited effectiveness of available mainstream treatments of bipolar disorder invite serious consideration of non-medication approaches. Natural supplements used to treat bipolar disorder include omega-3 fatty acids, magnesium, N-acetyl-cysteine, micronutrient formulas and Chinese herbal formulas. Some natural supplements may be safely combined with prescription medications increasing their efficacy. Most natural supplements are safe when a quality brand is used at the recommended dosage however some herbals and other natural supplements can have serious adverse effects especially when taken at inappropriate high dosages or in combination with prescription medications or other supplements. Non-biological approaches such as mindfulness-based cognitive therapy and yoga may help individuals improve their capacity for emotional self-regulation thus reducing the severity of mood swings.

If you are currently struggling with bipolar disorder and taking a medication that isn’t helping you control your mood swings, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Bipolar Disorder: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you feel and function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.

Bipolar Disorder: The Integrative Mental Health Solution will help you:
• Understand bipolar disorder better
• Take inventory of your symptoms
• Learn about non-medication treatments of bipolar disorder
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Bipolar disorder: The Integrative Mental Health Solution.

Welcome to my blog

This blog reflects my personal and professional commitment to providing reliable information about best evidence in alternative and integrative approaches in mental health care for the treatment of common mental health problems.

Goals of this blog and my website include:

  • Informing patients and medical practitioners about the evidence for non-conventional and integrative approaches in mental health care
  • Encouraging open-minded dialog about evolving understandings and novel approaches in assessment and treatment in mental health care
  • Providing a gateway
    to excellent web-based resources covering the range of biological,
    somatic, mind-body and energy-information therapies in mental health
    care

Announcing a series of e-books on integrative mental healthcare

Other books by Dr. Lake

Mental healthcare is evolving

A growing number of psychiatrists, psychologists, social workers, nurses and other mental health professionals around the world believe that existing conventional treatment approaches such as prescription medications and psychotherapy do not adequately address the mental health needs of people everywhere. There are many reasons for this. First of all, even though prescription medications are often effective and safe, they are not available in many parts of the world and where they are available they are often too expensive for many people to afford. The potential value of prescription medications for people who suffer with mental illness is also limited by the fact that many medications are no more effective than sugar pills and sometimes cause serious adverse effects. The limitations of prescription medications have resulted in renewed interest in complementary and alternative therapies, and efforts by mental health professionals, researchers and our patients to find more effective, safer and more affordable ways to treat many common mental health problems and prevent them from returning.

There is a long historical tradition of uses of so-called complementary and alternative (CAM) therapies in the U.S. and other Western countries in the background of the dominant framework of biomedicine. The rapid growth of CAM is being driven by consumer demands for a wide range of treatment choices, growing dissatisfaction with conventional medical care and increasing openness to new ideas in the leading institutions of Western medicine. Trends that are interfering with the ability of Western medicine to provide adequate health care include restrictions on the kind and quality of treatments available under managed care, private insurance contracts and Medicare; concerns over the efficacy and safety of conventional pharmacological treatments; and the increasing cost of medical care in general.

In the above context it is a significant fact that individuals who use CAM to treat any medical or mental health problem are generally more educated compared to those who use only conventional treatments. Approximately two thirds of all adults in the U.S. use various CAM approaches to treat a medical or mental health problem. Many individuals who see Western-trained physicians also see Chinese medical practitioners, herbalists, homeopathic physicians or energy healers for the same problem but many are also self-treating with herbals, supplements or homeopathic remedies without the advice of a naturopathic physician, conventionally trained M.D. or a mental health professional.

At the same time that patients are demanding more choices in health care, mainstream medicine is becoming more open to change. Courses on complementary and alternative medicine are now offered at most U.S. and European medical schools, and increasing numbers of physicians are becoming certified to practice Chinese medicine, herbal medicine, homeopathy and other established world healing traditions. Approximately one half of U.S. physicians refer patients to acupuncturists, naturopaths, homeopaths, chiropractors and other non-conventionally trained practitioners because they believe these approaches are safe and effective. Together these trends are stimulating evolution of medical care in the U.S. toward an eclectic network of perspectives, skills and services addressing the patient’s body, mind and spirit.

The Increasing uses of CAM in mental health care
Approximately one third of the adult population in the U.S. and Europe use at least one CAM therapy annually. In this context more and more people are using CAM and integrative therapies to treat or self-treat mental health problems. It has been estimated that as many as 10% of U.S. adults take prescription medications for depression, anxiety, schizophrenia and other mental health problems. At the same time approximately 10% of U.S. adults who visited an alternative medical practitioner in the previous year had a psychiatric diagnosis, and half of those had sought care specifically for a mental health problem. It is significant that the majority of individuals who see alternative medical practitioners for a mental health problem are self-referred and do not disclose their use of non-conventional therapies to their family physician, psychiatrist or therapist. Over 50% of individuals diagnosed with an anxiety disorder and 60% of individuals diagnosed with a mood disorder use a CAM therapy while few disclose this information to their family physician or psychiatrist. The majority of individuals who use CAM therapies see a conventionally trained M.D. for the same health problem. Among individuals hospitalized for a severe mental health problem almost two thirds had used a CAM approach within the past year and fully 80% had not disclosed this information to their psychiatrist. Severe depressed mood is the strongest predictor of CAM use in psychiatrically hospitalized individuals. The increasing rate of self-treatment in the context of non-disclosure of CAM use raises significant safety issues because many individuals who use vitamins, herbs or other natural substances also take prescription medications resulting in potentially serious toxic interactions.

Integrative mental healthcare uses approaches from Western biomedicine and CAM
The conventional biomedical model of mental health care widely practiced in the U.S. and many other countries emphasizes the use of potent prescription medications to treat ‘disorders.’ Medications will probably continue to play an important role in mental health care—especially in Western countries and especially for managing symptoms of severe mental health problems such as bipolar disorder, dementia and psychosis—however non-medication treatments will play an increasingly important role in mental healthcare as more research evidence accumulates showing that they are both safe and effective. In contrast to the conventional biomedical model, integrative mental healthcare is concerned with maintaining optimal wellness and managing symptoms of each unique person in the context of their values, preferences and circumstances. Advantages of integrative mental health care over the conventional biomedical model, include:

• improved response to treatment
• reducing the dosage of a prescription medication
• reducing adverse effects of prescription medications
• saving money on treatment costs
• having greater control over your symptoms
• greater emphasis on maintaining wellness
• developing a more personalized plan for treatment and prevention

It is important to point out that integrative mental healthcare does not reject the use of prescription medications, psychotherapy or other mainstream approaches or discount their benefits for mental health problems. Medications and psychotherapy are often beneficial and safe and bring enormous relief to human suffering. As integrative practitioners we often prescribe medications and recommend psychotherapy to our patients but we go beyond this limited model of care. In addition to these conventional biomedical therapies integrative practitioners also recommend a wide range of non-medication treatment approaches such as herbals, vitamins and other natural supplements, whole body approaches such as exercise and massage, changes in the diet, mind-body practices and energy therapies such as acupuncture and healing touch, and many other so-called ‘alternative’ therapies where scientific evidence supports their use. Because integrative mental health care focuses on each person’s unique needs and circumstances, treatment is often highly individualized. This means that there is no single ‘best’ treatment for any particular mental health problem, but each person may have a ‘most appropriate’ treatment plan depending on the particular symptoms they are experiencing in the context of their unique life story, values, preferences and circumstances.

Introducing a series of books on integrative mental healthcare
In an effort to address the limitations of the current model of mental health care, I have written a series of books on integrative mental health care. My chief goal in writing the books was to create a practical and affordable resource on safe and effective non-medication treatments for many common mental health problems. The books in the series provide concise reviews of the evidence for a variety of non-medication approaches used to treat many common mental health problems.
The series covers the following mental health problems:

Alcohol and Drug Abuse
Anxiety
Attention-deficit hyperactivity disorder (ADHD)
Bipolar disorder
Dementia and mild cognitive impairment
Depression
Insomnia
Post-traumatic stress disorder (PTSD)
Psychosis

Click here to learn more about my books and order them.