Charles Marmar, MD: The Differences in PTSD Treatment


How PTSD care can be, and should be, individualized for particular patient needs.

There is a wide-range of patients who suffer from PTSD, preventing a one-size fits all type of treatment from being effective.

In an interview with MD Magazine®, Charles Marmar, MD chair of the Department of Psychiatry and Director of the PTSD Research Program at NYU Langone Health, explained how different treatments work more effectively for individual patients.

MD Mag: Does treatment of PTSD differed based on the individual’s traumatic experience?

Marmar: Treatment differs somewhat based on age, gender, and type of trauma.

So, fundamentally the approaches we take to single event trauma, which occurs among otherwise healthy adults who have had an accident or an assault or a recent severe exposure to a life-threatening disaster event or terrorism, who were previously highly functioning before are usually time-limited.

They usually emphasize a practical short-term cognitive behavioral treatment which activates the memories of the trauma and helps the person process them.

Where necessary we have medications such as anti-anxiety and antidepressant medications. For specialized contexts such as combat trauma, which is more complex, more repeated and often occurs in people who are vulnerable before they went to the warzone.

We need longer-term treatments. It usually involves a combination of longer-term behavioral therapy, psychotherapy family therapy, and sometimes several medications and where we needed other forms of biological treatments such as newer treatments with transcranial magnetic stimulation ketamine, new drugs we're testing like cannabidiol.

So, the combat trauma because it often occurs over a longer period of time and involves a combination of traumatic events requires a more complex treatment.

Also, if patients present with trauma following repeated childhood exposures to sexual abuse, physical abuse, emotional abuse, and emotional neglect, they often also have more complex problems and need longer term treatment.

MD Mag: How does the age of the patient impact how PTSD is treated?

Marmar: Children, younger children are often treated with a form of play therapy where they reconstruct and reprocess the traumatic event through play.

For example, we treated a lot of children after the earthquakes in San Francisco, when I was a professor at the medical school in San Francisco and you create a play situation in for the children. You allow them for example, to build their house and then knock their house down and talk about what it was like for them to be in a home that was damaged during an earthquake.

So, we use play as a vehicle to start a conversation with children who have been traumatized. Children also may benefit from medications that block high levels of adrenaline in their system and other more conventional therapies as well.

There's some differences in treating adult men and women just based simply on gender. We know that certain drugs are more effective for men and for women. For example, among the most common FDA-approved drugs for PTSD, which are sertraline, Zoloft and paroxetine, Paxil, they're more effective in premenopausal women.

For postmenopausal women and men, drugs that have more complicated and less selective effects on serotonin work better. Drugs like Effexor, pristiq, and bupropion others generally work better in postmenopausal women and in men.

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