Last updated Thursday, 21-Aug-2008 19:39:41 MST

Most people know about the fight-or-flight response. It’s that amazing mechanism built into our bodies that helps us when we “perceive” a threat to our personal welfare. The fight-or-flight response is automatic and no willpower can overcome the automatic response. When our bodies undergo stress they automatically release three hormones – adrenaline (aka epinephrine), noradrenaline (more commonly norepinephrine) and dopamine. As a group, they are referred to as catecholamines. Why is it so important to understand catecholamines? Because catecholamines are the root cause of Post-Traumatic Stress Disorder (PTSD).

Contrary to common practice, chemicals that cause PTSD are not the same as those causing depression. While some symptoms may be similar, the treatment for depression and the treatments for post-traumatic stress are completely different. Remember, names are simply a convenient way to label a group of symptoms. If you think about it, there are many illnesses that share symptoms. For instance, both a cold and the flu look alike. However, we know that the “flu” is cause by the influenza virus while a cold is most commonly caused by a rhinovirus. Flu symptoms, while more severe, generally last for less time than a cold and, unlike a cold, can be prevented with a vaccine. So, how do we know whether it is PTSD or something else? Look for “marker” traits that distinguish PTSD illness from other diagnoses. You can learn more about symptoms post traumatic stress syndrome (PTSS) by reading PTSD Fact Sheet at Sidran.org.

PTSD can go undiagnosed for years, being falsely labeled a personality disorder (commonly as borderline or bipolar disorders), depression or even generalized anxiety. The scariest thing about this misdiagnosis is that most medications used to treat these illnesses make post-traumatic stress worse! This is particularly true in the case of depression and anxiety where the most common prescriptions are tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs, most often Wellbutrin). These are designed to “stimulate” individuals. One major marker trait of PTSD is that the body is already over stimulated. Therefore, taking medicines that stimulate the system turn a person struggling with PTSD into a crazed, uncontrollable maniac. This behavior often leads to suicide attempts and physical aggression. (For specifics about drugs which help and hurt PTSD, please see Med Ideas and Why or learn about the PTSD Cocktail.)

I think about post traumatic stress like this:

Imagine driving your car for 5 hours through the desert at 115 mph in the 115° F heat. The last time you changed the oil was in 1999 and you are running the air conditioner full blast. The engine is already hot and then you start up the foot of a steep mountain. The engine is over revved, it locks in gear and you can no longer downshift. Even though you are climbing into cooler temperatures, the long trip of repeated exposure to intense conditions has caused the engine to seize. Until you pull over, let the engine cool down completely and give it some basic maintenance, your car will never run properly. Each time you try to push it a little further, you “trigger” the engine. In response, the car shakes, trembles, whines and sweats from exertion. The only way to get your car back is to let it rest and recuperate for hours on end. Meanwhile, traffic keeps moving, life passes by and you are left stranded on the side of the road. You are 100% aware of what happened and even why, but you are powerless without time and the right tools to get your car back on the road. It’s impossible to get anywhere or get anything done. You must stay on the side of the road and wait it out. Every time you try to convince the car to “get over it” and push it onto the road, the problem gets worse until going another foot with the engine running finally causes the car to collapse in the middle of the road. All that’s left is to tow it to the nearest scrap heap.

Just like that car, people with PTSD are over revved and overheated. The slightest trigger, even if it wasn’t the original cause of the problem, starts them trembling, shaking and sweating from the exertion of trying to control PTS chemicals. The flow of catecholamines is overwhelming, taking control of the body’s response. The constant flow wears down the body and causes it to break down. Post traumtic stress is just as viscious and unforgiving as cancer. While there is not a tumor to point at, just imagine the adrenal glands sitting on top of your kidneys. Shake a finger at them any time you are frustrated with the symptoms of PTSD. If you need proof it exists, just pay attention to the hair loss, weight fluctuations, skin changes and other physical signs. While post traumatic stress syndrome may be triggered by events that create an "emotional" response, those emotions are dictated by the chemicals in our bodies. Willpower alone will not shut them down. The brain has to be retrained and new pathways have to be created for healing to be permanent. Read more in our Research Grant and Curing PTSD. The way to begin healing is to find a way to take control away from the chemicals and give it back to the individual. This is why we recommend the PTSD Cocktail.

Adrenaline (epinephrine) is created from norepinephrine. Adrenaline acts on the beta-adrenergic receptors in your brain. This means that its effects are quite visible externally. These effects include shaking, sweating and trembling. Inderal (propranolol) reduces adrenaline by blocking those beta-adrenergic receptors. Adrenaline prepares the body for crisis by increasing your heart rate, dilating the pupils and restricting blood flow to the gastrointestinal (digestive) tract and skin while increasing blood flow to the skeletal muscles. This is why people with post traumatic stress have a rapid heart rate, even at rest, and are sensitive to light. When released, adrenaline boosts the supply of oxygen and glucose (sugar) to the brain and suppresses other less critical processes like digestion. This explains why individuals with PTSD often experience digestive distrubances. Adrenaline increases blood sugar levels by breaking down fat cells as well as glucose in the liver. The extra energy makes it difficult to sleep and increases agitation. Adrenaline, like other stress hormones, also suppresses the immune system.

Noradrenaline, also called norepinephrine, works on the alpha-adrenergic receptors and causes effects similar to getting the jitters from caffeine. While one may feel like he/she is shaking, no trembling is visible. Prazosin works by blocking the alpha-adrenergic receptors in the brain. As a catecholamine, norepinephrine acts like adrenaline by increasing heart rate, releasing glucose and increasing blood flow to the skeletal muscles. Unlike adrenaline, norepinephrine is psychoactive and can affect the brain. It plays a large role in attention and focus, which explains why many PTSDers report being highly productive and capable of multitasking even before they fall ill with PTSD. It is also why using drugs commonly presicribed for ADD/ADHD can make post traumatic stress symptoms even more extreme because those drugsincrease norepinephrine and dopamine. A dangerous combination for any person with post traumatic stress. When norepinephrine acts like a drug, it increases blood pressure and also triggers a reflex that reduces heart rate. Norepinephrine is created from dopamine, so medicine like Geodon (Zeldox, ziprasidone) which blocks dopamine reception will also decrease the production of norepinephrine.

Dopamine, like the other two catecholamines, also increases heart rate and blood pressure. However it's effects on mood are the most pronounced. Dopamine affects cognition, motivation, competition, sexual arousal, awareness, alertness, sleep, motor activity, attention, and learning. While elevated levels can be useful, once dopamine becomes imbalanced by being overstimulated with post traumtic stress syndrome, the hyperaroused individual can be unsafe. Elevated levels of dopamine explain why PTSD often leads to acts of violence against one's self or others. So, while Inderal (propranolol) is excellent for blocking a panic attack, Geodon (Zeldox) is critical for preventing the tragedy of suicide and acts of rage against others. Non-competitive aerobic exercise is also extremely useful for reducing dopamine in the system. Try running, skipping, rowing, cycling or a home punching bag to reduce dopamine levels.

The bottom line is that post traumatic stress is more than an idea in your head. It is a physical illness, so no matter how often you are told to “get over it,” the bottom line is that simple thoughts cannot cure PTSD any more than they can cure cancer. Medication is crucial for bringing your body back under your control. Then, like with any other disease, you can use willpower to undergo the "physical therapy" of retraining your body on when and how much catecholamines should be released. So, the next time someone tells you to "get over it," just give them our card! ;)

 

 

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