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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am a fireman and have been through some traumatic incidents.

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I am a fireman and have been through some traumatic incidents. Lately I have been having a lot of flashbacks of the horrific incidents I've been to. I have been depressed and I've been losing sleep and it's now affecting my wife and family. A very close friend and coworker has been on some of the same calls and he was prescribed Valium for this. Would that work for me? And should I tell my doctor this and ask for the Valium? I have basically no good memories of my wife and kid or other good times but I remember EVERYTHING from the "bad" things

Dr. Z :

Hello

Dr. Z :

I believe I can help you with your concern

Dr. Z :

Please give me a couple minutes to read over your question carefully to assist you better

Dr. Z :

I am so sorry that you have been experiencing these symptoms, I can imagine how distressing this is for you

Dr. Z :

What you are actually describing is most likely Post-Traumatic Stress Disorder (PTSD) which is not uncommon for your occupation. Medications are not typically a cure for PTSD, but they can lessen the symptoms greatly for you, although therapy is the only true way to cure it

Dr. Z :

I can recommend some good therapy techniques and medications you can ask your prescribing physician about if you like.

Customer:

Ok

Dr. Z :

By the way PTSD is usually mix of anxiety and depression, but your symptoms seem more anxiety related. Here is a good link describing PTSD in more detail for you

Dr. Z :

So these techniques take root in Cognitive Behavioral Therapy (CBT) which is the most evidence based treatment for PTSD. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help him keep track of any negative thoughts he has. He puts the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want him to come up with an alternative thought for the situation (more objective and plausible). This will help him change his way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

Dr. Z :

In addition, these two worksheets are very good at helping lessen PTSD symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with symptoms of PTSD have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Dr. Z :

In addition these books can be helpful as well

Dr. Z :

Now regarding medication, Valium is very good and it is a benzodiazepine, so this can be physically addicting if you take it too often, which is why you want to take it as needed. But in addition, you may also want a SSRI antidepressant to take regularly. I would recommend Lexapro at 10-20mg as it is fast acting, more effective than most antidepressants, has great anti-anxiety effects, and has less side effects.

Dr. Z :

But for a complete list of appropriate medications, I will suggest this link.

Dr. Z :

So the combination of medication and CBT therapy is the best treatment protocol to "cure" these symptoms for a sustained period of time.

Dr. Z :

Also the Valium is the easiest of the benzodiazepines to not be physically addicted to as well, so it is good to start with that if you choose to use a benzodiazepine

Dr. Z :

Do you have any questions or concerns?

Customer:

Ok would I go to my doctor or a specialist?

Dr. Z :

You can get this from your general practitioner, but if you would like a specialist you can go to a psychiatrist although it is not necessary

Customer:

The reason I ask about the medication is because I already work shift work and have a horrible sleep schedule, but lately my off nights sleeping at home have been just as bad with the flashbacks. I'm having another baby soon and I don't want to be so phyisally and mentally drained that it further affects my family.

Dr. Z :

Then the benzodiazepine will help with your sleep as it has a sedation effect and will prevent the flashbacks to help you sleep too, so take it before you fall asleep.

Dr. Z :

The SSRI antidepressants do not cause you to fall asleep and actually can disrupt sleep, so you want to take that during the daytime

Customer:

I always get nervous asking for a specific medication because I don't want the doctor to think the wrong thing.

Customer:

Do you know what I mean?

Customer:

I don't think the doc has enough time to hear everything that is making this happen but I want him to understand that things are just not OK anymore

Dr. Z :

I understand, well discuss what you told me about your friend and co-worker who suggested Valium, that is a good approach and then describe your symptoms and what your job is. There should be no difficulty getting the benzodiazepine with those explanations. And the SSRI antidepressant are not addictive at all, so there is no worries there

Dr. Z :

Your doctor is there for you, so explain your symptoms and that you believe that you have symptoms of PTSD and you would like some medications to augment the therapy techniques that I recommended.

Customer:

Ok thank you. Now I know where to start and that is a big help

Dr. Z :

Anytime, is there anything else I can help you with?

Customer:

No I think that is all for now. Thanks again

Dr. Z :

I am happy that I was able to help you tonight. I wish you the best with your treatment and I hope that your symptoms resolve soon. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime. Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Customer:

Absolutely, will do!

Dr. Z :

Thank you it is much appreciated :)

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