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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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I am a retired vet with DX if OTSD some stemming from childhood

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I am a retired vet with DX if OTSD some stemming from childhood and other from service. i did not go to combat but as a physical therapist I treated those who have returned...some with brutal daily treatments. I have been taking klonopin.25mg 3x/day and .50mg trazodone at night. My other regular med are viville dot.05mg patch changed once a week, lipitor 10mg, 81mg asprin and dexalant 60 mg for GERD. My body does not react well to medications with 2 episodes of hospitalizations after changing medications, one with serotonin syndrome. My new provider wants me to decrease my klonopin and add resperidone .125 mg 2x/day. since I do not react well to many medications to include:buspar, ambien, paxil, narcotics, and just a 50 mg increase in my trazodone caused tachycardia I am afraid to try this medication. I went through a very bad period of take this med...no take this med from a provider right after I retired and do not want to begin that cycle again. I do have periods of range with little provocation, depression and anxiety. I am in counseling for PTSD receiving EMDR which seems to be helping. The provider who want to start the Risperidone is from a VA clinic and I have only met once....confused/scarred about putting a different med into my body due to side effects or prior medications. Any suggestions?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.

Hi! I believe I can be of help with this issue.



First let me say that I can imagine how distressing and frustrating this situation must be for you. And thank you for your service to our country. That you were a therapist with the soldiers coming back with such experiences is not only a great service but a traumatic one. So again, thank you. I will also at the end of the posting give you a technique you can use to help with your anxiety from the post traumatic stress disorder (PTSD) you are suffering. It will help you find some temporary relief with your anxiety. It is not a cure, but a technique to use throughout the day.

I'm not sure what studies you've seen that compare risperidone with a placebo specifically with PTSD. Meds do not treat PTSD directly. They can help with the associated symptoms of anxiety, aggressive anger, etc. I've seen risperidone work better than most other meds in the case of rage and anger associated with anxiety. So my bias is favorable toward it.

The question of whether you should introduce another medication into your system is a fair one. It is a question of benefit vs. risk. Right now you're in therapy and it's going well. If you feel that you are doing better with the symptoms of anger and rage from anxiety, then you might decide that the risk is not worth the benefit. But if you need the boost with your aggression, then risperidone might be of benefit that outweighs the risk. This is something you should discuss with your doctor and with your therapist and then weigh the two opinions. If you trust your therapist, his/her opinion may carry more weight here.

Psychotherapy that is helpful for PTSD is some form of Exposure Therapy. You're having EMDR and that's great. I am trained in it and have found it useful. Exposure therapy is also very helpful. I have found that you need to combine these types of therapy with a more introspective, humanistic or psychodynamic approach. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. But many EMDR practitioners and therapist working with Exposure Therapy do not take the time to insure the emotional safety of the patient and so that's why you need someone who is more humanistic or psychodynamic in approach. I am writing all this only because I want to make sure that you are getting a chance to work through things as well as just the EMDR protocol.

If in the future you need someone else who is practicing more of a talk therapy style so you can work through the childhood issues as well and you don't have a good referral source, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (you can see a photo of the therapist!) look at the listing and see if they list working with PTSD and EMDR and also some form of psychodynamic or humanistic therapy in their orientations. You will need this for the work on the self worth problems as well that you need to address. And make sure you are confident in them as a therapist and they share your values.

http://therapists.psychologytoday.com/rms/

I wish you the very best!

Finally, I am going to put here a protocol that is used for anxiety. It's often that there's an underlying anxiety we have to address. So I want to give you this technique to help you!

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks as well.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety and negative thinking is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5087
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and 4 other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
Thank you for your advise and exercise. I do use breathing as a way to help with anxiety and am aware of the relaxation technique. I will start to practice it to help calm me down when I feel rage building. Part of my fear with beginning the new medication is the mulitple adverse reactions I have had to so many different medications with two landing me in the hospital. I also have liable HTN which has gone extremly high(crisis levels for prolong periods of time) from different medications. I had an adverse reaction to the medication the hospital gave me for my HTN crisis and went from stoke levels to 60/40 in a very short period of time so part of my anxiety does include changes in medication. I am hoping to begin talk theray at the local VA and am becoming more active in my church to take focus off myself and onto helping others. Thank you again.
Expert:  Dr. Mark replied 2 years ago.
Labile HTN is very, very stress related. I'm sure you know that, but I want to make sure. Thus, I am most concerned with the new meds causing an anxiety reaction. That increases their risk and certainly the chances of failure. So instead, focus on therapy. I'll give in on the risperidone if you monitor your aggressive and raging tendencies to truly evaluate that therapy is helping curb the problem. Okay?


I am very skeptical about VA talk therapy because I've not seen consistent effort put by the VA into it. Thus, the vets wind up being short changed. There isn't a strong relationship formed with one therapist that is with them for the long term.


I would very much like you to consider looking at the Psychology Today directory and seeing if there's someone who writes they work with a sliding scale, sliding fee. It shows if they do in their listing. Or someone who takes your veterans' insurance.


Choose someone who seems sharp, wise, and sensitive. And make one of the treatment goals to see how you are doing with the aggressive anger.


All the very best to you, Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5087
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and 4 other Mental Health Specialists are ready to help you

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