Understanding Trauma: How Medications Help with PTSD and Developmental Trauma
- jonslaughtermd
- 5 days ago
- 6 min read
To discuss medications for post-traumatic stress disorder (PTSD) effectively, we first need a clear way to understand what living with trauma feels like. In my experience, the foundation of healing starts with two powerful tools: awareness (understanding your condition) and self-compassion (being kind to yourself). To learn more about self-compassion, see my post on The Power of Self-Compassion in Treating PTSD, Depression, and Anxiety. Medications are also helpful, working on the brain and body’s stress response systems to ease PTSD symptoms.
The Trauma Response: Your Body’s “Flight, Fight, Freeze” System
Our brains and bodies are built to keep us safe by spotting and avoiding danger. This happens through a complex system called the “flight, fight, freeze” response. When you sense a threat, your first instinct is to flee (run away). If that’s not possible, you fight. If neither works and danger feels unavoidable, you freeze, hoping to go unnoticed.
What makes an experience traumatic? It’s not just what happens but what you believe will happen during the event. To be diagnosed with PTSD, you must feel intense helplessness or horror, often tied to a fear that you or a loved one faces death or serious injury.
How Trauma Changes the Brain and Leads to PTSD Symptoms
Symptoms of Hyperarousal
After a traumatic event, your brain and body “update” to stay on high alert, constantly watching for similar dangers. This creates a state called hyperarousal, where your threat detection system is overly active. People often mistake this for “anxiety,” but it’s more complex. Unfortunately, many doctors and therapists aren’t trained in trauma-informed care, so PTSD symptoms are sometimes misdiagnosed or labeled “treatment-resistant.” This can frustrate both the person struggling and their healthcare providers. Sadly, some clinicians may give up or even show frustration toward the person suffering, which no one deserves when they’re already navigating so much pain.
Hyperarousal symptoms include:
Emotional distress: Feeling anxious, scared, powerless, confused, or disconnected from your emotions, others, or the world.
Physical reactions: Racing heart, shortness of breath, muscle tension, sweating, or stomach issues (like cramping, indigestion, or needing to use the bathroom urgently).
Hypervigilance: Always on guard, expecting something bad to happen.
Sleep problems: Trouble falling or staying asleep (at least 90% of people with PTSD have insomnia).
Intrusive thoughts: Unwanted worries about the trauma or something catastrophic happening.
Irritability: Feeling easily upset or on edge.
Poor concentration: Struggling to focus.
Avoidance: Steering clear of people, places, or topics that remind you of the trauma.
Avoidance is especially tough. When you avoid trauma triggers, your brain sees them as threats, which worsens hyperarousal and symptoms like hypervigilance.
Symptoms of Depression, Poor Attention, and Impulsive Behavior
If hyperarousal lasts a long time, other PTSD symptoms can develop:
Depression: Your mood may sink, making it hard to feel joy or stay interested in activities you once loved. You might pull away from friends, family, or hobbies.
Trouble with attention/concentration and impulse control: The brain’s heightened state can disrupt the frontal lobes, which handle concentration and self-control. This makes everyday tasks at home or work harder. Some people may act impulsively, engaging in risky behaviors, especially with substance use or sex.
Developmental Trauma: A Special Case
When trauma happens repeatedly during childhood—often through physical or sexual abuse within the family, which sadly occurs more often than society acknowledges—it’s called developmental trauma or complex trauma. This type of trauma, which can be ongoing or intermittent, is harder to treat than a single, discrete trauma because it shapes the brain as it forms. The threat detection system gets stuck on “high alert,” causing symptoms even without a real threat.
When trauma involves verbal or emotional abuse (with or without neglect), its impact is often overlooked because it doesn’t involve the risk of death or injury required for a PTSD diagnosis. Yet, children still feel fear, powerlessness, confusion, and disconnection, leading to lifelong suffering. Those with developmental trauma are more likely to develop chronic medical conditions, increasing healthcare costs and lost workdays for individuals and society. Trauma-informed clinicians are advocating to expand our understanding of trauma to include developmental trauma.
Survivors of developmental trauma often feel chronic inadequacy, which affects their personal and professional lives and fuels imposter syndrome. These feelings were once labeled as low self-worth or poor self-esteem, but we now see them as temporary states that can be healed through cognitive defusion and self-compassion. To learn more, see my post on Step One and Then One Step to Change the Way You Feel.
Dissociation: Your Brain’s Emergency Brake
Our brains have a built-in safety mechanism called dissociation that kicks in during overwhelming fear or helplessness. It’s like pressing an emotional “pause” button to shield you from intense distress. This causes the feelings of disconnection mentioned earlier. While it helps in the moment, it leads to significant challenges over time.
Dissociation makes you feel disconnected from your emotions, other people, or the world. This can hurt relationships, make it hard to feel fulfilled, and affect work by reducing focus and engagement. People often describe feeling “numb,” “off,” or “spaced out.” In more intense cases, the world might feel unreal, like watching a movie (derealization), or you might feel detached from your body, as if watching yourself from above (depersonalization). If someone says things feel “weird,” it might signal dissociation.
How Medications Fit Into a Treatment Plan
The most effective treatment for PTSD and developmental trauma is trauma-informed psychotherapy—talk therapy designed to address trauma’s effects. Therapies like Compassion-Focused Therapy, Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Somatic Experiencing have proven benefits. Learn more about a holistic approach combining therapy and medications in my post on An Integrative Holistic Approach to Using Medications.
Medications play a supporting role by targeting symptoms in three areas: hyperarousal, depression, and cognitive issues (like trouble focusing). They work by calming the brain and body’s stress responses, particularly adrenaline, which drives the flight-fight-freeze system. While medications don’t cure trauma, they can lower symptom intensity, making therapy more effective. Since the brain is incredibly complex, we’re still learning about trauma’s impact, but medications are valuable tools.
Medication Classes for PTSD and Developmental Trauma
Below are key medication types used to manage PTSD and complex trauma. The first groups treat overall post-traumatic symptoms, while others target specific issues to reduce distress.
Adrenaline Blockers
These medications target the body’s stress response by blocking adrenaline receptors (alpha or beta).
Prazosin
Prazosin blocks adrenaline at alpha receptors in the brain’s threat detection areas. It reduces nighttime symptoms (like nightmares and insomnia) and daytime symptoms (like emotional distress or hypervigilance). Over time, as these symptoms ease, depression and focus issues may also improve, helping with all PTSD symptoms.
Propranolol
Propranolol blocks adrenaline at beta receptors, mostly in the heart, lungs, and muscles, which are active during the flight-or-fight response. It helps reduce physical symptoms like a racing heart, shortness of breath, sweating, or stomach distress, making trauma triggers less overwhelming.
Serotonergic Medications
These medications adjust brain chemicals to ease PTSD symptoms across hyperarousal, depression, and cognitive issues. They include:
SSRIs (e.g., Zoloft, Prozac, Lexapro, etc.): Commonly used, with some FDA-approved for PTSD, they help “turn down” symptom intensity.
SNRIs (e.g., Effexor, Pristiq, Cymbalta, etc.): Similar to SSRIs but less frequently used.
Tricyclic Medications (e.g., nortriptyline, imipramine, etc.): Older medications that require careful use due to a higher risk of side effects.
Sleep Medications
Sleep issues are common in PTSD. Medications like prazosin (mentioned above), gabapentin, Ambien, Trazodone, or orexin antagonists (e.g., Quviviq) can improve sleep, reducing overall distress.
Anti-Anxiety Medications
Benzodiazepines (e.g., Ativan, Klonopin, Valium, etc.) can help with severe anxiety but must be used cautiously. Use shortly after a discreet trauma may actually increase PTSD risk, but in specific cases, they improve functioning when distress is overwhelming.
Stimulants
Medications like Adderall, Vyvanse, or Ritalin can help with focus and impulse control, especially for those with significant inattention or risky behaviors. Improving these symptoms can reduce overall stress and hyperarousal.
I’ll explore the above medications in detail, including how they work and where they fit in a treatment plan, in a future post.
Disclaimer
This blog is for informational and educational purposes only and is not medical advice, diagnosis, or treatment. Information about psychiatric medications, their uses, or side effects is general and not a substitute for professional medical advice from a licensed psychiatrist or healthcare provider. Always consult a qualified healthcare professional before starting, stopping, or modifying any medication or treatment plan. Individual responses to medications vary, and only a licensed professional can assess your specific needs. The author is not responsible for any adverse effects or consequences from using this information. By reading, you acknowledge that this content is not a replacement for professional medical care and assume all risks of applying or misinterpreting it.
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