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khagihara
khagihara, Doctor
Category: Mental Health
Satisfied Customers: 6484
Experience:  Trained in multiple medical fields for many years
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I have a question regarding best medication combination ptsd

Customer Question

I have a question regarding best medication combination for chronic ptsd in an Aspergers's brain. Even when I am not have a traumatic breakdown or shutdown, my brain is always processing flashbacks both positive and negative.
JA: OK. The Psychologist will need to help you with this. Please give me a bit more information, so the Psychologist can help you best.
Customer: My brain is always "on autoprocess". I have been diagnosed with chronic/complex ptsd because of all the chronic emotional abusive people I dealt with. My aspergers's made the ptsd bottle up and engrain it. I have multiple sources of trauma each causing their "individual ptsds" and are making my brain a baseline ptsd brain. How do I get the right combination of medications and therapy that addresses the multiple traumas plus Aspergers? I have made tremendous progress with EMDR, sudarshana kriya yoga, and am on well butrin 100mg for two weeks but I need much more. I am 26 years old and this was caught last year.
JA: When you start doubting if you are seeing the world in the same way as everyone else it's time to talk to out Expert - or go live on a desert island. Is there anything else important you think the Psychologist should know?
Customer: No. I explained the problem as best as I can with the details I thought that would be important to you: Aspergers and PTSD to put it succinctly. I am not trying to offend anybody. I clicked on the website link and you just happened to pop up offering to help me. I deeply appreciate it.
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Psychologist about your situation and then connect you two.
Submitted: 5 months ago.
Category: Mental Health
Expert:  khagihara replied 5 months ago.

You should have a trauma-focused cognitive-behavioral therapy (CBT). If you prefer medications to the psychotherapy. You should have medication (a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). As an example, paroxetine can be started at 20 mg/day orally. If minimal or no clinical response is seen after three to four weeks, increased doses in 10 to 20 mg/day increments can be tried, up to 60 mg/day. Although there are fewer studies assessing the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) than SSRIs in PTSD, two randomized trials found venlafaxine extended-release (ER) to be more effective in reducing PTSD symptoms than placebo. We suggest adjunctive use of an atypical antipsychotic for PTSD symptoms resistant to SSRIs/SNRIs. As an example, start risperidone at 0.5mg orally, increase after five to seven days if the response is inadequate up to 4 mg/day. If no clinical benefit is seen after two to three weeks of treatment at the maximal tolerated dose, gradually discontinue the medication. We suggest trauma-focused CBT as an adjunctive treatment in patients with PTSD who have only responded partially to an SSRI or SNRI. We suggest treatment with prazosin for patients with PTSD who experience sleep disruption or nightmares or other PTSD symptoms. This medication can be used alone or as an adjunct to an SSRI or SNRI.

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