Ending Nightmares Caused By PTSD
by AMY STANDEN
January 16, 2012 4:00 AM
Some patients with PTSD suffer recurring nightmares of a single event.
Everyone has nightmares sometimes. But for people with PTSD, it’s different.
Sam Brace doesn’t want to talk about what he saw when he was a soldier in Iraq eight years ago. In fact, it’s something he’s actively trying not to dwell on. But what he can’t control are his dreams.
They’re almost always about the same explosion. “When I was overseas, we’d hit an IED,” Brace says. “When I have a nightmare, normally it’s something related to that.”
Healthy dreams seem kind of random, according toSteven Woodward, a psychologist with the National Center for PTSD at the VA Medical Center in Menlo Park, Calif. “They’re wacky,” he says. “They associate lots of things that are not normally associated.”
PTSD dreams are the same real-life event played over and over again like a broken record. “Replicative nightmares of traumatic events … repeat for years,” Woodward says. “Sometimes 20 years.”
Scientists wanted to find out the reason why people with PTSD can’t sleep and dream normally. One theory comes from Matthew Walker, a psychology researcher at the University of California, Berkeley. His particular interest lies in rapid eye movement, or REM. It’s the time during sleep when a lot of dreaming occurs.
It’s also a time when the chemistry of the brain actually changes. Levels of norepinephrine — a kind of adrenaline — drop out completely. REM sleep is the only time of day when this happens. That struck Walker as a mystery. “Why would rapid eye movement sleep suppress this neurochemical?” he asks. “Is there any function to that?”
Walker found that in healthy people, REM sleep is kind of like therapy. It’s an adrenaline-free environment where the brain can process its memories while sort of stripping off their sharp, emotional edges. “You come back the next day, and it doesn’t trigger that same visceral reaction that you had at the time of learning.”
Emotions are useful, he says. They show us what really matters to us. “But I don’t think it’s adaptive to hold onto that emotional blanket around those memories forever,” he says. “They’ve done their job at the time of learning, then it’s time to hold on to the information of that memory, but let go of the emotion.”
Walker’s theory suggests that in people with PTSD, REM sleep is broken. The adrenaline doesn’t go away like it’s supposed to. The brain can’t process tough memories, so it just cycles through them, again and again.
So, what if you could make the adrenaline just go away? Enter prazosin.
Pfizer Inc. introduced the drug under the brand name Minipress in the 1970s to treat high blood pressure. Dr. Murray Raskind, a VA psychiatrist in Seattle, says the drug, now generic, can cost anywhere between 5 and 15 cents. And, actually, it’s not terribly effective as a blood pressure medication, he says.
But what prazosin does do is make people less sensitive to adrenaline. About a decade ago, Raskind starting giving prazosin to some of his PTSD patients, including one Vietnam War veteran.
“He had this recurrent nightmare of being trapped by the Vietcong forces in a landing zone and having his best friend killed in front of his eyes by a mortar round,” Raskind says.
After a few weeks of treatment with prazosin, the veteran came in for a follow-up appointment. Raskind says the veteran told him that he wasn’t sure the medication was working. He was still having the same dream over and over — just about something else. He told Raskind that in the new dream he was in his fifth grade classroom and there was a test. If he didn’t pass the test, he wasn’t going to be promoted to the next grade. But he never even got the assignment.
“I said, ‘That’s my nightmare!’ ” Raskind says.
Indeed, the veteran’s new dream was the stress dream of a healthy brain trying to work things out, Raskind says.
This year, the VA is expected to finish up its trial for prazosin. It’s already prescribing the drug to about 15 percent of its PTSD patients. Raskind, of course, would like to see that number rise.
“To us, it’s a simple thing that works,” he says.
Ending Nightmares Caused By PTSD
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Christchurch quake impact yet to hit
Not picking up prescriptions, binge drinking and delaying medical checkups are signals ”the full impact of the earthquakes” is still to come, Canterbury’s health officials say.
Canterbury District Health Board chief executive David Meates today gave a presentation to the board about the medium-term impact of Hurricane Katrina on people’s health.
The research looked at dangerous behaviours, such as smoking, drinking and substance abuse, lack of self-management where a person’s health was concerned and the increase of depression and post-traumatic stress disorder, three years after the deadly natural disaster hit the south of the United States.
Meates said Canterbury’s health system was ”already seeing red flags” in some areas.
”We’ve seen a drop off in the number of prescriptions being picked up. People aren’t following or completing courses of medication and people are turning up in the health system later on and their presentations are more complex because of it,” he told the board.
”These issues are red flags that mean we have to keep a close eye on this and know what’s coming.”
Many people had started smoking again after the quakes and ”household breakups, domestic violence and divorce” were on the rise, he said.
”Binge drinking is starting to become quite a major factor of what we’re dealing with … and people are seemingly deferring or choosing not to have certain surgical procedures because there’s too much other stuff going on in their lives.”
Meates said the community and the health system had showed ”incredible resilience” after the quakes, but the next two to three years ”would make the first two look easy”.
Board member Olive Webb said health workers were ”also dealing with these issues themselves”.
”We have staff who are binge drinking, not taking their pills and fighting with their husbands and wives,” she said.
Another board member, Elizabeth Cunningham, said housing and financial difficulties were having a ”significant impact” on the community’s overall health, and Chris Mene said proposed school mergers and closures affected families in the ”most deprived and vulnerable areas”.
Andrew Dickerson said the ”appalling performance” of the Canterbury Earthquake Recovery Authority, the Earthquake Commission and insurance companies would take its toll on people’s mental wellbeing.
Defence boss writes to troops urging open attitude, writes Danya Levy.
There are calls for more research and funding for post-traumatic stress disorder amid concerns the Christchurch earthquake and deployment of troops into combat zones could cause the number of sufferers to soar.
It comes as the Defence Force releases figures showing an explosion in the number of soldiers being assessed as having psychological conditions such as depression, anxiety and post traumatic stress disorder (PTSD).
The number has grown from 39 in 2006 to 134 last year.
While army figures have risen and fallen over the five-year period, figures for the navy and air force have grown from single digits to 45 and 44 respectively.
There have been five suicides in the past six years. Two further deaths – Corporal Douglas Hughes in Afghanistan in April and Private Alexander Stewart Rope near the Linton Army Base last Friday – are being considered by the coroner.
Chief of the Defence Force Lieutenant General Rhys Jones said the apparent increase in mental health cases in the navy and air force could be attributed to the introduction of electronic records.
Data from the Chief Coroner showed New Zealand had a national suicide rate of 1 in 8000, while Defence Force statistics were 25 per cent lower at 1 in 10,000.
PTSD sufferer and former Lieutenant Colonel Bill Blaikie said there was likely to be an increase in people with the disorder following the Christchurch earthquake, particularly in emergency services workers, and within the Defence Force following attacks on New Zealand troops in Afghanistan.
“A lot of those people are already out there but are not being picked up at the moment. We need to put some study into how many cases there are.
“PTSD is one of those illnesses which is put in the too hard basket.
It gets left behind because it covers depression, anxiety and avoidance issues.”
Labour’s associate health spokesman, Iain Lees-Galloway, said while there was much talk about mental illness, there wasn’t a lot of discussion about the impact of trauma.
“Any mental illness has a significant impact on families. Children growing up in the presence of mental illness or trauma are impacted more probably than those growing up in the presence of a physical illness.”
A draft of the Government’s response to the Mental Health Commission’s blueprint for improving mental health showed no additional funding for services for the 2012-2017 period, Mr Lees-Galloway said.
Associate Health Minister Peter Dunne said the mental and emotional fallout from the earthquakes had been substantial and the Canterbury District Health Board was already providing services for those suffering from quake- related stress.
“The Government is doing everything it can to support people through an incredibly difficult and extended time.’
There was already good research in place and PTSD was just one aspect of mental health the Government was continually working on, he said.
It is Mental Health Awareness Week and General Jones wrote to troops this week saying mental health needed to be talked about openly to avoid people being stigmatised.
“If you are having issues you probably couldn’t be in a better place.
We’ve got five layers of support that people can turn to for
assistance: chaplains, psychologists, medical, command chain and mates.” Fairfax NZ
5:30 AM Thursday Oct 4, 2012
Minister of Defence makes a secret visit to Afghanistan with NZ’s military chief
Defence Minister Jonathan Coleman. Photo / Steven McNicholl
Defence Minister Jonathan Coleman says some comrades of the New Zealand troops killed in Afghanistan will need ongoing support when they get back home to prevent mental health issues into the future.
“I don’t think you can pretend that once these guys get home, suddenly you can close the door on that chapter,” he told the Herald last night from Dubai.
“I think people will need ongoing support to make sure you are not at risk of long-term mental health effects from this,” said the minister, who is also a qualified doctor.
Dr Coleman has just completed a secret visit to Bamiyan with the chief of Defence Force, Lieutenant General Rhys Jones, following the deaths of five troops in August.
In the past 10 years in Afghanistan, the New Zealand Defence Force has lost 10 soldiers.
Dr Coleman and General Jones added plaques to the cairn at Camp Kiwi in a brief commemorative ceremony when they first arrived on the latest visit.
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The visit also coincided with the crossover between the departing Crib 20 and the arrival of the final rotation of Crib 21 before New Zealand departs for good by the end of April.
Dr Coleman said Crib 21 was thrilled to be going home after six months.
Asked about morale, he said the reality was that different individuals would react very differently to what had happened.
“And some I think will be quite affected by this experience for a long time to come and others who you think might be more affected may not be so affected.”
Dr Coleman would not comment on whether he had met up with the four SAS troops who have returned to Afghanistan to gain intelligence on the insurgents in the northeast of the province responsible for the latest five deaths.
Nor would he say whether patrolling had resumed in the northeast, but he did not visit the area on the trip.
He spent much of his time looking at the development projects New Zealand is funding in Bamiyan, including agriculture projects using what are known as “McCully tractors”.
Foreign Minister Murray McCully has spearheaded a drive to get greater mechanisation into agriculture, including the provision of 60 tractors.
Local small-time farmers had been formed into co-operatives and paid a subscription for the use of tractors, for access to seed technology and access to animal vaccines. The result was bigger crops and healthier animals.
“The locals are raving about it,” Dr Coleman said. “It has made it incredibly more productive.”
He also visited a New Zealand solar power energy project under construction that is expected to supply 35 per cent of the town. He said it would be run by a private local company and the provincial government.
The NZ Defence Force was building a dormitory for 100 young men at the Bamiyan teachers’ college opening in about a month.
“It feels like a place which is really going ahead,” Dr Coleman said.
But there was no doubt that the security situation in the northeast still concerned people.
By Audrey Young Email Audrey
Eighty-seven troops have been released from the Defence Force on mental health grounds in the past five years and a further 67 needed help after assisting in the aftermath of the Christchurch earthquake, new figures show.
Defence Force chief Lieutenant General Rhys Jones has written to soldiers urging them to seek help for mental illnesses such as post-traumatic stress.
His letter was prompted by former top-ranking soldier Lieutenant Colonel Bill Blaikie speaking out about his struggle with the disorder to The Dominion Post.
A former deputy director of intelligence for the combined forces in Afghanistan, Mr Blaikie’s life fell apart after he returned to New Zealand in 2004 and he twice attempted to take his own life.
General Jones’s letter revealed mental illness figures within the Defence Force. In addition to those released and given help after assisting in Christchurch, it said nine cases of post-traumatic stress had been diagnosed since 2007.
“I believe these numbers are likely far lower than the actual numbers among us who will be struggling to come to terms with some aspect of their service,” he wrote. “Nor do they take into account the recent incidents in Afghanistan.”
Ten New Zealand troops have been killed in Afghanistan and about a dozen injured.
Help was available, General Jones said.
“I think we still do have too much of a macho culture around such issues. The courageous thing is not to suffer in silence.”
Mr Blaikie said international research showed more than a quarter of returned servicemen and women were likely to need help for stress-related, emotional or mental health problems. “So obviously we are not capturing all of those people.”
All troops on operational missions receive psychological support from the Defence Force before, during and after their deployment. There is also training in mental health areas throughout their careers.
Personnel are interviewed by a psychologist and complete a medical exam within three months of returning to New Zealand.
By DANYA LEVY
– © Fairfax NZ News