Monday, February 16, 2009

Yes, the solution can be worse than the problem

Stress exposure, and post-traumatic stress disorder, are horrible problems. I've seen them wreak havoc on peace of mind, careers, and relationships. I think sometimes, being on the outside looking at a friend, loved one, or patient going through something we'll never completely understand because we simply did not live through it, creates anxiety because we have no productive outlet for the compassion and healing we want to provide.

As much as the object of our concern may be struggling, and as hard as we may want to be the source of relief for their pain, we need to always be careful that the help we provide is not being administered on behalf of our own pain, and not the person who is truly suffering.

For example, consider this recent study, that looked at the consequences of administering alprazolam (Xanax), a benzodiazepene anxiolytic, to a stress-exposed individual.

Animals exposed to stress were then given alprazolam on two different schedules; one group was medicated for 3 days starting 1 hour after the stress, while the other group received the medication for 3 days starting a week later. Each group was tested for symptoms of PTSD 30 days after the initial trauma.

Those animals who were immediately medicated experienced immediate relief, with now observable problems at day 30. Sounds good, except that when the rats were exposed to the same trauma a second time, they had a greater "freezing response" (something that traumatized animals and people do in stressful situations).

Early exposure also disrupted normal stress hormone function both during and outside of the second stress exposure.

So while we might feel better giving someone medicine to help them feel better, we may actually be the only ones who feel better. In the long run, the person may suffer more and longer than if we'd let them process the trauma in the way the body is programmed to naturally do, providing a safe, supportive place to heal and only introducing chemical intervention if it is deemed absolutely necessary.

Matar MA, Zohar J, Kaplan Z, Cohen H. Alprazolam treatment immediately after stress exposure interferes with the normal HPA-stress response and increases vulnerability to subsequent stress in an animal model of PTSD. Eur Neuropsychopharmacol. 2009 Jan 22. [Epub ahead of print]

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