Our Lives With Post Traumatic Stress Disorder and Traumatic Brain Injury

FYI

Physiological Changes in PTSD

PTSD causes many things to change. These changes are all encompassing. Physical, psychological and social changes can affect every aspect of our lives. In this article I want to share what some of those changes are and how they affect someone with PTSD.

First, lets look at the physical changes. Studies have shown that there are structural changes that occur in the brains of people with PTSD.

It is known that sensory input, memory formation and stress response mechanisms are affected in patients with PTSD. The regions of the brain involved in memory processing that are thought to cause these changes in PTSD include the limbic system (amygdala, hippocampus) as well as the frontal cortex. While the heightened stress response is likely to involve the thalamus, hypothalamus and the locus coeruleus.

Limbic System: The limbic system, sometimes referred to as the “emotional brain,” is a group of brain structures located deep within the cerebrum. It is composed of the amygdala, the hippocampus, and the hypothalamus. These three structures are involved in the expression of emotions and motivation, particularly those related to survival. Such emotions include fear, anger, and the “fight or flight” response. The limbic system is also involved in feelings of pleasure that reward behaviors related to species survival, such as eating and sex. In addition, limbic system structures have functions related to memory storage and retrieval, particularly memories related to events that invoked a strong emotional response.

Amygdala: The amygdala contains some of our most primal instincts. One of these physical events associated with fear is often called the “fight or flight” reaction:  increased heart rate and force of each beat (“pounding heart”); increased muscle tension that can even cause tremors; sweaty but cold palms; and even nausea and diarrhea.  Another aspect of fear is a physical “conditioning”, so that even a minor stimulus can bring on the whole fear reaction. The amygdala seems to respond to severe traumas with an un-erasable fear response. It seems to be genetically different and “wired” for a higher level of fear in some individuals, such as those with panic disorder or PTSD.

Hippocampus: The hippocampus is part of the limbic system and is responsible for transferring information into autobiographical and fact memory. It may function as a memory “gateway” through which new memories must pass before entering permanent storage in the brain. Hippocampal damage can result in anterograde amnesia (loss of ability to form new memories, although older memories may be safe). Thus, someone who sustains an injury to the hippocampus may have good memory of his childhood and the years before the injury, but relatively little memory for anything that happened since. MRI studies have shown marked changes in this area of the brain in those with PTSD. These changes are thought to be caused by increased exposure to cortisol (the ‘stress’ hormone).

Hypothalamus: The hypothalamus is an area of the brain that produces hormones that control body temperature, hunger, moods, sex drive, sleep, thirst and the release of hormones from many glands, especially the pituitary gland. The pituitary gland is a critical part of our ability to respond to the environment most often without our knowledge.

Prefrontal Cortex: This area of the brain controls cognitive behavior, personality, decision making, and the orchestration of thoughts and actions in accordance with internal goals as well as appropriate social behavior.

Is it any wonder, since PTSD effects so many areas of the brain that every case is very different? Looking at the various symptoms of PTSD, you can begin to see the correlation to the various parts of the brain. Memories, avoidance, hyperarousal can all be linked back to physical changes in the brain.

When you really look at the physiological changes, you can see the reasons behind the reactions in a person with PTSD. These aren’t things that we choose to happen. Our brains have been traumatically rewired. The way thoughts and experiences are processed are vastly different than those without PTSD. The slightest trigger can cause a ‘fight or flight’ response that we cannot control. Adrenaline surges through our bodies at inappropriate times (such as someone accidently dropping a box, what would normally cause a simple startle reaction instead causes us to reach in a much more visceral way).

Perhaps as the medical community continues to learn more about brain function as well as the effects of PTSD and TBI on the brain, more treatments and preventative measures can be discovered. Until that time comes, we continue our fight against PTSD.

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PTSD by Any Other Name…

So it seems there is a public hearing in Philadelphia today to discuss changing PTSD to PTSI. They are pondering whether changing it from ‘disorder’ to ‘injury’ will remove some of the stigma and open soldiers up to getting treatment. While this is a valiant effort to persuade more soldiers get the help they need, Shakespeare’s quote comes to mind, “A rose, by any other name…”.

Changing the name of PTSD is not going to get soldiers to seek treatment. Far too many soldiers already avoid going to sick call (the military’s version of an urgent care, same day appointments for medical treatment) because they fear being labeled as malingering or somehow not as worthy a soldier as their peers. Too often they wait to seek treatment until what was a minor problem has become a major issue. Even when they do seek treatment, more often than not they are met with nothing more than a prescription to treat the symptoms rather than exploration of the cause.

Rather than changing the name, what needs to occur is a change in mentality among the military’s leadership. You hear far too many stories of soldiers who suddenly went from super-troop to rag-bag in the eyes of their commanders simply because of they chose to seek treatment and were diagnosed with PTSD and that is where the stigma originates.

For those of us with PTSD, it is not something we chose. We are not automatically weaker than our brothers and sisters. Is it an injury? Yes. Studies have shown that PTSD causes physiological changes in our brains. We process things differently than we did before this came into our lives. Our command wouldn’t treat a soldier differently who was physically injured in combat but could still perform his job, so why are we being treated like lepers simply because of what is essentially a brain ‘injury’ which in and of itself causes a ‘disorder’.

Over the past century, the military has had to integrate several demographics into their ranks; first african americans, then women, and most recently openly gay soldiers. The integrations were never smooth, they were often met with personal bias and bigotry. Perhaps what these people need to figure out is how to force the military to accept and treat equally those service members with unseen disabilities. Those who suffer the effects of PTSD and/or TBI. That is the true way to remove the stigma of seeking treatment for PTSD, not simply changing the name.

Do you think changing the name from Post Traumatic Stress Disorder to Post Traumatic Stress Injury will make a difference? If  not, what would help encourage soldiers to seek treatment?


PTSD FYI

Today was not a banner day for me. I feel the need to share a little ‘PTSD FYI’ with everyone. This is something my therapist shared with me… If you are taking an SSRI (Zoloft, Prozac, etc), unless it means life or death, AVOID STEROIDS AT ALL COSTS!

About a month ago, my family doctor put me on a short course of Prednisone to reduce the inflammation around the nerve in my back. It helped marginally while I was taking it, however it completely ERASED my Zoloft and Seroquel. I was a train wreck for two weeks with anxiety attacks, irritability and depression. My therapist said Prednisone is actually the worst drug to give a patient with PTSD.

Now…back to today. As mentioned in a previous post, I had a spinal steroid injection yesterday. I promise not to regale you with the gory details beyond saying I’ve seen better bedside manners in an inner-city DMV than from this doctor. Needless to say things didn’t go well. Anyway, I didn’t think the small amount of steroid that was injected (their version of sedation was a joke) would be enough to effect my SSRI….well, I was wrong!

I spent most of the day still sore from the injection which was bearable until my lunch date showed up unexpectedly. There I was, trying to relax and enjoy my afternoon when anxiety and panic arrived uninvited. There was nothing going on, no stimuli, no intrusive thoughts or flashbacks, there was simply fear and panic. Thankfully it was a short visit, but panic attacks always leave me extremely irritable for the rest of the day.

Long story short…if you have PTSD and take an SSRI, avoid steroids (especially prednisone)!