PTSD & Treatment

From "In a Nutshell" by Peter S. Mueller, M.D., P.A. (edited to clarify terminology):

Post-Traumatic Stress Disorder (PTSD) - An organic disorder caused by the shrinkage of the hippocampus and probably amygdala secondary to stress hormone (cortisone and adrenocorticotropic hormone (ACTH), not epinephrine) inhibition of neurogenesis and may often be associated with temporal lobe epilepsy (TLE) problems secondary to traumatic brain injury (TBI).

1) Diagnosis: Criteria from the DSM IV, pp. 424-429.

2) Severity: I use the Carlson Self-Rating form (SPTSS) but there are several others which can be found in the Physician's Desk Reference (PDR) under the PTSD data on Paxil.

3) Other Diagnostic Tests: Single photon emission computed tomography (SPECT), Positron emission tomography (PET) and volumetric magnetic resonance imaging (MRI)

4) Treatment:

* Meridia (Sibutramine): for total repair on average of 10.8 days with 50% in the first 24 hours. 90% respond to 10 mg bid p.o. No side effects. This may be permanent often after 1½ to 2½ months. May then stop Meridia without recurrence. ***
* Antiepileptics: If SPECT and PET positive for TLE.
* L-Carnitine: Check for carnitine deficiency; give carnitine supplements if needed.

5) Other Treatments (not recommended):

* Zoloft and Paxil: 35% with several toxic deaths. Response takes weeks to months if at all. May require other drugs such as Seroquel and Klonopin which add to the toxicity.
* Propranolol: has no effect.

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Dr. Mueller has the use patent for Sibutramine for treatment of PTSD as well as other disorders. The U.S. Government is interested but wants Dr. Mueller to pay for the efficacy trials. Abbott Laboratories, owners of the compound patent, refuses to work with Dr. Mueller in any capacity, and in fact attempted to duplicate Dr. Mueller's use patent.