Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that may occur after someone has seen or experienced a traumatic event that involved the threat of injury or death. PTSD can occur at any age, and can follow a natural disaster such as a flood or fire, or events such as assault, domestic abuse, prison stay, rape, terrorism and war. For example, the terrorist attacks of September 11, 2001 may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends. Likewise, veterans returning home from a war often have PTSD.1 This article will examine various aspects of PTSD, including conventional medicine treatments and the use of nutraceuticals.
PTSD Prevalence
The lifetime risk for PTSD in the United States is estimated to
be up to eight percent. It is estimated that about 6-30 percent
or more of trauma survivors develop PTSD, with children and
young people being among those at the high end of the range,
and women have the twice the risk of PTSD as men.
PTSD Symptoms
There are three main categories of PTSD symptoms. These
include: 1) re-experiencing the trauma through intrusive
distressing recollections of the event, flashbacks and
nightmares; 2) emotional numbness and avoidance of places,
people and activities that are reminders of the trauma;
and 3) increased arousal including difficulty sleeping and
concentrating, feeling jumpy, and becoming easily irritated
and angered. People with PTSD might also feel guilt about
the event, including survivor guilt. Typical of anxiety, stress,
and tension, additional symptoms may include agitation or
excitability, dizziness, fainting, feeling your heart beat in your
chest, and headache. Although many of these symptoms of
PTSD may be an appropriate initial response to a traumatic
event, they are considered part of a disorder when they persist
beyond three months.2
PTSD Biochemistry
Psychological, genetic, physical, and social factors are involved
in PTSD, resulting in changes to the body's response to
stress. It affects the stress hormones and neurotransmitters
(chemicals that carry information between the nerves).3 PTSD
may also be associated with shrinkage in the brain associated
with memory and learning, possibly due to the continued
release of the stress hormone cortisol.
Psychotherapy for PTSD
Psychotherapy with a mental health professional is commonly
used to help PTSD. This can occur one-on-one or in a group.
Types of psychotherapy that can help people with PTSD include
exposure therapy (helps reduce symptoms by encouraging
people to remember the traumatic event and express your
feelings about it), cognitive restructuring (helps people make
sense of the bad memories), and stress inoculation training
(tries to reduce PTSD symptoms by teaching a person how to
reduce anxiety). Support from family and friends can be an
important part of therapy.4 Clinical research also shows that
relaxation therapy can significantly reduce feelings of anger
and guilt in patients with PTSD compared to baseline.5
Conventional Medications for PTSD
Symptoms of PTSD, such as anxiety, can be reduced by
medicines that act on the nervous system. This includes antidepressant medications known as selective serotonin
reuptake inhibitors (SSRIs), and other anti-anxiety and sleep
medicines.
SSRIs
SSRIs help to increase the levels of the neurotransmitter
serotonin in the brain. This type of antidepressant has also
been used to treat panic disorder, obsessive-compulsive
disorder (OCD), and generalized anxiety disorder (GAD).
Furthermore, in a published, scientific review of 35 shortterm
randomized controlled trials of medication therapy for
PTSD (4597 participants), a significantly larger proportion
of patients responded to medication (59.1 percent) than to
placebo (38.5 percent). Symptom severity was significantly
reduced in 17 trials (2507 participants), with the largest trials
showing long-term effectiveness for SSRIs.6 In addition, the
U.S. Food and Drug Administration (FDA) have approved two
SSRI medications for treating adults with PTSD: sertraline
(Zoloft) and paroxetine (Paxil). Both these medications may
help control PTSD symptoms such as sadness, worry, anger,
and feeling numb inside—while making it easier to go through
psychotherapy.7
Sometimes people taking these medications have side
effects. The effects can be annoying, but they usually go away.
However, medications affect everyone differently. Any side
effects or unusual reactions should be reported to a doctor
immediately.
Other Medications
Other types of medications which may also be prescribed
for PTSD include benzodiazepines and other SSRIs.
Benzodiazepines help reduce anxiety, which in turn may help
people relax and sleep. In addition to sertraline and paroxetine,
the antidepressants fluoxetine (Prozac) and citalopram
(Celexa) can help people with PTSD feel less tense or sad.8
Nutraceuticals for PTSD
Nutraceuticals which have application for PTSD include those
which promote healthy serotonin levels (St. John’s Wort
and L-tryptophan), as well as those that reduce anxiety and
promote relaxation (GABA and L-theanine).
St. John’s Wort
St. John’s Wort (Hypericum perforatum) has been used as
medicine since the middle ages. Its primary mechanism of
action seems to be that it functions as an SSRI, increases
serotonin levels.9 Other research also indicated that St.
John’s Wort may increase some aspects of brain dopamine
function in humans.10 Like serotonin, dopamine is also a
neurotransmitter, which is often found in inadequate levels in
depressed individuals.
The clinical evidence is overwhelming in favor of St. John’s
Wort Extract as an antidepressant which is suited for the
treatment of mild to moderate depression. In one study, after
4-6 weeks, all patients showed a measurable improvement in
anxiety, mood, loss of interest, and11 more than one-half dozen
other psychometric measurements.12 Similar results were
seen in other studies.
Research on St. John’s Wort extract is so extensive, that it
has been endorsed by the German government’s ‘Commission
E’ as indicated for impaired consciousness, depressive states,
fear, and nervous disturbances.13 There have been many
evaluation studies comparing St. John’s Wort to both a placebo,
and various anti-depressant pharmaceuticals. Not only have
these studies validated St. John’s Wort over placebos, they
have demonstrated a therapeutic advantage over prescribed
drugs in some cases.14 And, occurrence and severity of side
effects with Hypericum extracts are clinically insignificant,
especially when compared to those of the pharmaceutical
counterparts. For example, in one study comparing Hypericum
to fluoxetine (Prosac®) for mild to moderate depression, the
researchers concluded, “When treating patients with mild to
moderate depression, hypericum should be considered as
one of the first treatment options based upon both efficacy
and safety, particularly in cases where treatment is a choice
between fluoxetine and hypericum.”15 The current dosage
recommendation for St. John’s Wort is 300 mg of the extract,
three times daily, for total of 900 mg.
L-tryptophan
L-tryptophan (LT) is an essential amino acid, which means that
it must be consumed from food since the body cannot make
it using other amino acids. It is present in virtually all plant
and animal proteins. Once the body absorbs LT, it converts
it into 5-hyrdoxytryptophan (5-HTP), and ultimately into the
neurotransmitter serotonin.
First and foremost, LT is an effective sleep aid. Certainly,
LT has significant sedative-like properties, although unlike
other sedatives it does not appear to impair performance.16
Specifically, LT is not associated with impairment of
visuomotor, cognitive, or memory performance, nor does it
elevate threshold for arousal from sleep.17
At least 20 years’ worth of research (including 40
controlled studies)18 has demonstrated that LT can help
induce sleepiness in humans. The weight of the evidence
suggests that doses of 1 gram or more is effective. In younger
insomniacs, LT is effective in inducing sleep the first night of administration, while in more chronic, well established
insomnia or in more severe insomnias, repeated administration
of low doses of L-tryptophan over time may be required for
therapeutic improvement.19
One particular study20 found that LT may be effective in
doses lower than 1 gram. In 15 mild insomniacs 1 gram of
LT helped reduce the amount of time it took to fall asleep,
although lower doses of 1/4 g and 1/2 g produced a trend in the
same direction. Stage IV sleep was significantly increased by 1/4
g of L-tryptophan.
Selective serotonin reuptake inhibitors (SSRIs) are
a category of drugs commonly used for the treatment of
depression. SSRIs work by blocking serotonin transporters
so serotonin remains for a longer time and is more available
to brain neurons. So, does LT have value in the treatment of
depression since it is the precursor to LT? The answer seems
to be yes; at least when used in combination with other
antidepressant medications.
In a randomized, double-blind, placebo-controlled trial,
30 patients with major depressive disorder were treated for
over eight weeks with 20 mg of fluoxetine (Prozac) per day
and either tryptophan (2 to 4 grams per day) or a placebo.
The results were a significantly greater decrease in depression
scores in the tryptophan/fluoxetine group than in the placebo/
fluoxetine group. Since 4 grams of LT seemed to cause some
daytime drowsiness, 2 grams of LT appeared to be the optimal
amount. The authors concluded that “Combining 20 mg of
fluoxetine with 2 g of tryptophan daily at the outset of treatment
for major depressive disorder appears to be a safe protocol that
may have both a rapid antidepressant effect and a protective
effect on slow-wave sleep.” [Note: Due to the risk of serotonin
syndrome (a rare, but potentially life-threatening adverse drug
reaction from excess serotonergic activity at central nervous
system and peripheral serotonin receptors), do not take LT
with an SSRI medication without the prior approval from your
physician.]
GABA
In the central nervous system, GABA (gamma-aminobutyric
acid) is the primary inhibitory neurotransmitter. It exerts
anticonvulsant, sedative, and anxiolytic effects at the cellular
level.22,23 Orally, people have used GABA supplements
for relieving common, everyday anxiety, elevating mood,
relieving premenstrual symptoms, and helping to improve
attention and concentration.24 A number of physicians have
reported beneficial effects in stress and anxiety with GABA
supplementation.25
PharmaGABA™ is a natural form of GABA manufactured
from probiotic bacteria.26 Unlike synthetic GABA,
PharmaGABA™ appears to cross the blood-brain barrier
and increase brain alpha waves and decrease beta waves to
promote relaxation. In fact, the effect of orally administrated
PharmaGABA™ on relaxation and immunity during stress has
been investigated in humans. Two studies were conducted.27
The first evaluated the effect of PharmaGABA™ intake by 13
subjects on their brain waves. Electroencephalograms (EEG)
were obtained after three tests on each volunteer as follows:
water intake only, PharmaGABA™, or L-theanine. After 60
minutes of administration, PharmaGABA™ significantly
increased alpha waves and decreased beta waves compared
to water only or L-theanine. These findings denote that
PharmaGABA™ not only induces relaxation but also reduces
anxiety.
The second study was conducted to see the role of
relaxant and anxiolytic effects of PharmaGABA™ intake on
immunity in stressed volunteers. Eight acrophobic subjects
were divided into 2 groups (placebo and PharmaGABA™).
All subjects were crossing a suspended bridge as a stressful
stimulus. Immunoglobulin A (IgA) levels in their saliva were
monitored during bridge crossing. Placebo group showed
marked decrease of their IgA levels, while PharmaGABA™
group showed significantly higher levels. In conclusion,
PharmaGABA™ could work effectively as a natural relaxant and
its effects could be seen within one hour of its administration
to induce relaxation and diminish anxiety (it may have actually
worked sooner, but saliva was only tested after one hour).
Moreover, PharmaGABA™ administration could enhance
immunity under stress conditions.
L-theanine
Asian cultures have often used teas for relaxation effects. The
relaxing effect is caused by the presence of a neurologically
active amino acid, l-theanine (gamma-ethyl-amino-L-glutamic
acid). Tea has the reputation of having less caffeine than
coffee but it is the L-theanine in the tea that lessens the
stimulant effect of caffeine on the human nervous system. In
the brain, L-theanine increases both serotonin and dopamine
production28, and possibly GABA as well.29 Evidence from
human electroencephalograph (EEG) studies show that it also
significantly increases brain activity in the alpha frequency
band which indicates that it relaxes the mind without inducing
drowsiness. Alpha activity is also known to play an important
role in critical aspects of attention. Research indicates that
L-theanine has a significant effect on improving mental
alertness while promoting relaxation.30 According to Mason,
two small human studies31 showed that within 30–40 min of
consuming 50 or 200 mg of L-theanine there is an increase
of alpha wave activity/electrical signals produced by the brain. The perceived relaxation effect in the subjects coincided with
the detection of alpha waves. This shows that L-theanine
fosters a state of alert relaxation, which is consistent with the
fact that anxious people have fewer or smaller alpha waves.
In a double-blind placebo-controlled study, sixteen healthy
volunteers received 200 mg L-theanine, a pharmaceutical
anxiolytic or placebo. The results showed that L-theanine
induced feelings of tranquility in the volunteers.32
In a double-blind, placebo-controlled study, twelve
participants underwent four separate trials: one in which
they took L-theanine at the start of an experimental, stressinducing
procedure, one in which they took L-theanine midway,
and two control trials in which they either took a placebo or
nothing. The results showed that L-theanine intake resulted
in a reduction in physiological indicators of stress, compared
to the placebo or control condition. Moreover, analyses of
heart rate variability indicated that reductions in heart rate
were likely attributable to a reduction of sympathetic nervous
activation, suggesting that L-theanine had anti-stress effects
via the inhibition of cortical neuron excitation.33
Nutraceutical Dosage
St. John’s Wort extract 900 mg daily
L-Tryptophan 1000-2000 mg daily
PharmaGABA™ 100-200 mg daily
L-Theanine 100-200 mg daily
B-Complex* 50-100 mg daily
Vitamin C* 500-1000 mg daily
Magnesium* 300-700 mg daily
*B-Complex, Vitamin C and Magnesium
are general nutrients that are used up
rapidly during stress and should be
replenished.
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