Depakote for ptsd

Living With: PTSD (Posttraumatic Stress Disorder)

You may feel that you are on your own if you or a loved one has been diagnosed with Post-Traumatic stress disorder. However, PTSD is a common problem and many resources are available for people affected by this anxiety disorder. Approximately 5 percent of people in the United States suffer from PTSD, and 8 percent of the population has had PTSD at some point. PTSD is generally caused by a traumatic event and is twice as likely to affect women as it is to affect men. The treatments for PTSD are highly effective at helping the affected individual, especially with the support of family members.


PTSD is generally caused by personally experiencing or witnessing a traumatic event. This can include a single event such as a serious accident, assault or sudden death of a loved one. Repeated experiences during childhood can cause PTSD such as abuse or neglect. Combat situations like being tortured, taken hostage or imprisoned can also cause PTSD. Less severe forms of stress such as getting divorced, being fired from a job or failing in school don’t usually cause PTSD.


A diagnosis of PTSD requires the patient to exhibit specific sets of symptoms that last for at least one month. These symptoms can be classified into three general categories. The patient may reexperience the traumatic event, which may take the form of flashbacks that occur while the patient is awake or nightmares when the patient is sleeping. The patient may also experience exaggerated physical or emotional reactions to events known as triggers. The second set of symptoms for PTSD is avoidance behavior of things that are related to the traumatic event. This also includes a loss of interest in related activities or feelings of detachment from other people. The third set of PTSD symptoms is an increased level of arousal, which includes sleeping difficulty, problems with concentration, irritability and an exaggerated startle response.


PTSD may be divided into subtypes including acute, chronic and delayed PTSD. The symptoms of acute PTSD last between one to three months and seriously impair the patient’s ability to function. The diagnosis may be changed to chronic PTSD when the symptoms last for longer than three months. Chronic PTSD is less likely to improve without treatment than acute PTSD, and these patients should seek treatment immediately. Delayed PTSD occurs when the symptoms recur after being absent for at least several months. This recurrence often happens on the anniversary of the event that initially caused the PTSD or when the patient experiences a similar event.

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The treatments for PTSD may generally be divided into psychotherapy and medication. Some patients respond well to one treatment modality, while other patients require both modalities. Psychotherapy is usually the best treatment for PTSD when the symptoms are mild or when medication is contraindicated, as is the case in pregnant or lactating women. Some patients may have a medical condition that prohibits the use of psychoactive medication used to treat PTSD. Medication is more likely to be the preferred treatment for PTSD when the symptoms are severe or persistent. Patients who have other psychiatric problems may also benefit from medication, especially when psychotherapy has been ineffective by itself.


The most effective forms of treatment for PTSD include anxiety management, cognitive therapy and exposure therapy. Anxiety management teaches patients skills that will help them cope with the symptoms of PTSD. These include relaxation training, breathing retraining, positive thinking, assertiveness training and thought stopping. Cognitive therapy involves changing the patient’s irrational beliefs that interfere with psychological functioning and create emotional disturbances. Exposure therapy requires the patient to confront specific triggers that produce the symptoms of the PTSD. This can include psychological exposure in the form of memories or physical exposure to real situations. Play therapy can also be an effective psychotherapy for children with PTSD, in which children act out their anxiety with recreational activities.


Selective serotonin reuptake inhibitors are the preferred antidepressants for the medical treatment of PTSD. SSRIs currently available in the United States include Zoloft, Paxil, Prozac, Luvox and Celexa. Other antidepressants that may be prescribed when SSRIs are ineffective include Effexor. The next choice of medication for treating PTSD is the older tricyclic antidepressants such as Elavil, although they have more side effects than the newer drugs.

A psychiatrist may also prescribe mood stabilizers such as Depakote if the patient shows a limited response to antidepressants. Mood stabilizers are most often used to treat PTSD when the patient’s primary symptoms are prominent anger or irritability. Patients are also likely to receive mood stabilizers if they have bipolar disorder.

Antianxiety medications such as benzodiazepines can be used to treat PTSD when anxiety is its most dominant symptom. The primary choices include Valium, Xanax, Klonopin and Ativan. Benzodiazepines should only used on a short-term basis due to the potential of a dependence developing.

Family Support

Family members can be an important part of a patient’s recovery from PTSD if they are good listeners and provide emotional support. They must avoid the temptation to simply tell patients to get on with their lives. Patients usually have the best chance of recovering from PTSD when they receive encouragement from family members to share the memories of the traumatic event.

The family members of a PTSD patient can also help the patient get rid of the guilt they often feel by telling them they are not to blame and are not alone. Family members must also have realistic expectations about a patient’s recovery from PTSD, while encouraging patients to seek exposure to triggers. Support groups are also a common method of helping patients and family members deal with PTSD. These support groups are available through a variety of organizations.

For more on the topic of Living With PTSD, we’ve included the following expert consensus documents as reference materials:

  • Guide for Patients and Families in pdf

View Resources

  • UOregon – War zone stress reaction and PTSD
  • IOM – PTSD treatment
  • Mason – information about PTSD
  • UIC – veterans with PTSD
  • SDSU – The psychobiology and psychopharmacology of PTSD


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Divalproex in posttraumatic stress disorder: an open-label clinical trial

Clinical Trial

. 1999 Apr;12(2):395-401.

doi: 10.1023/A:1024797014210.

R D Clark  1 , J M Cañive, L A Calais, C R Qualls, V B Tuason



  • 1 Department of Pharmacy, VA Medical Center, Albuquerque, New Mexico 87108, USA.
  • PMID: 10378177
  • DOI: 10.1023/A:1024797014210

Clinical Trial

R D Clark et al. J Trauma Stress. 1999 Apr.

. 1999 Apr;12(2):395-401.

doi: 10.1023/A:1024797014210.


R D Clark  1 , J M Cañive, L A Calais, C R Qualls, V B Tuason


  • 1 Department of Pharmacy, VA Medical Center, Albuquerque, New Mexico 87108, USA.
  • PMID: 10378177
  • DOI: 10. 1023/A:1024797014210


Posttraumatic stress disorder (PTSD) is characterized by intrusive, avoidance, and hyperarousal symptoms. This study was conducted to investigate the effectiveness of divalproex in reducing PTSD symptoms, depression, and anxiety in patients with PTSD. Sixteen patients with a DSM-IV diagnosis of PTSD at the Albuquerque VAMC outpatient PTSD treatment program received an open-label trial of divalproex. The patients were evaluated at baseline and at 8 weeks by a trained rater using the Clinician Administered PTSD Scale (CAPS), the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). Plasma valproate levels were measured at the 8-week post-treatment assessment. Three patients stopped the medications due to side effects. Intrusion and hyperarousal symptoms decreased significantly, while no significant change was seen in avoidance/numbing symptoms. Depressive symptoms, as measured by the HAM-D, unexpectedly decreased at post-treatment assessment. HAM-A scores also decreased significantly. Controlled trials are needed to further study the efficacy of divalproex in the treatment of PTSD.

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MeSH terms


A cure for PTSD?


Fluorescently labeled macrophages, confocal microscopy

: 14.07.2015

In recent years, there has been increasing evidence of the relationship between mental processes and the functioning of the immune system, in particular, inflammation. The results of clinical trials of some drugs indicate that against the background of taking anti-inflammatory drugs, symptoms of depression decrease. And clinical trials of the antibiotic minocycline in a small sample of patients with schizophrenia have shown that it can reduce inflammation in the brain and thus reduce the symptoms of this disease.

The next step is to develop a therapy for post-traumatic stress disorder (PTSD) by interfering with the immune system. This disorder occurs after a severe psychotraumatic event associated with a serious threat to health and life - military operations, a terrorist act, a serious illness, the death of a loved one. Such trauma causes an experience of intense fear, horror and helplessness, and intrusive memories of the past can cause more stress than that felt at the time of the traumatic event itself.

Researchers analyzed the association of PTSD symptoms in people with this disease with blood levels of one of the immune components, C-reactive protein. It turned out that people with elevated levels of this protein in the blood serum (including those in whom this increase is genetically determined) are more prone to developing post-traumatic stress disorder.

The results of experiments on laboratory mice and rats have shown that, indeed, "fine tuning" of the immune system may be the key to treating or even preventing post-traumatic stress disorder. In a study led by M. Young of the National Primate Research Center. Yerkes in Atlanta (USA) animals were taught to be frightened by the sound, which was turned on simultaneously with the electric shock to the paws. Then the animals underwent a standard experimental procedure for eliciting an immune response - they were injected with bacterial polysaccharides, substances present on the outer shell of microorganisms. Twelve hours later, the scientists tested the mice's response to the sound and found that the injected animals became more fearful of it than the control group.

Another instructive experiment was carried out by K. Lowry's group from the University of Colorado in Boulder (USA). Scientists injected lab mice with the non-pathogenic soil bacterium Mycobacterium vaccae to change their immune systems. The scientists then placed animals from this and control groups in cages with larger, more aggressive animals. The vaccinated mice, unlike the control mice, did not capitulate to the aggressor, but tried to fight it. In addition, their intestines remained healthy, while in animals from the control group, a change in the intestinal microflora characteristic of a stressful state and intestinal inflammation developed.

The following experiment was carried out on laboratory rats: animals vaccinated with M. vaccae were subjected to an electric shock with simultaneous sound activation, after which they became frightened by just one sound signal. Then this fear was “extinguished”, including only the sound, but canceling the electric shock. It turned out that rats with a stimulated immune system ceased to be afraid of sound much faster than control animals. In the near future, scientists are preparing to conduct clinical trials of therapy using bacteria M. vaccae .


Photo by ZEISS Microscopy Labs, Germany

Source: zeissmicro/8574591304

Copyright: https://creativecommons. org/licenses/by-nc-nd/2.0

Image resized

Prepared by Maria Perepechayeva

: 07/14/2015

3 Change your brain

Post-traumatic stress. Change your brain - change your life!


Change your brain - change your life!
Amen Daniel


Post-traumatic stress disorder


Mark, a fifty-year-old top manager, came to our clinic after a suicide attempt. His wife started the divorce proceedings and he felt like his whole life was falling apart. He became angry, hostile, irritable, distrustful and constantly in a state of anxiety. Colleagues believed that he was "constantly angry." In addition, he complained of persistent headache. Mark is a veteran of the Vietnam War, has military decorations, served in the infantry. On account of his more than a hundred killed. He told me that in Vietnam he lost his humanity and that the experience made him insensitive.

In the hospital, he said, he was tormented by memories of the past. Mark suffered from post-traumatic stress disorder. When his wife left him, he decided that life had lost its meaning. The symptoms looked quite ominous, especially since Mark had suffered a head injury in Vietnam. I prescribed SPECT.

Out of range results. We found significantly increased activity in the basal ganglia in the left side of the brain. I have never seen such hyperactivity in this area before. Left-sided dysfunction of the basal ganglia is often found in people who are constantly in an irritable or angry state. In these cases, mood-stabilizing drugs such as lithium, Tegretol, or Depakote help reduce irritability and help calm "warmed-up" areas in the brain. I assigned the brand Depakote. Almost immediately, the headaches stopped, and he became calmer. He stopped lashing out at others and was able to work on his mental recovery from his divorce and trauma in Vietnam.

Mark's Brain - PTSD and Headaches

3D view of the active brain from below. Note the increased activity of the basal ganglia on the left (arrowed).

While working with Mark, I had the impression that being in Vietnam had reprogrammed his basal ganglia to be on constant alert. Throughout the 13 months that he spent in the war, every day he had to remain "on the alert" so that he would not be killed. For all subsequent years, he did not have the opportunity to reprogram his brain to work normally. Psychotherapy and medication helped him to feel, for the first time in 25 years, that he had actually stepped out of the war zone.


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