So much is going on...
Acute Stress Disorder (ASD)
We All Know Stress
Stress, by definition, is a chemical, emotional or physical influence that causes an individual mental, physical or emotional tension (Jones, T. L. 2001). Every person experiences their own stress: emotional, physical and mental. Hard day at work, arguing with a loved one, carrying a child, purse and the groceries... it is all stress. Every person experiences and acts out their stress differently, as well. A stressed infant may cry, a stressed teenager may slam doors and blast their music, and a stressed adult may pour a glass of wine or read a good book. These are normal every day stressors, but for some individuals, these normal stressors are much more intense as they live with a form of a stress disorder such as post traumatic stress disorder – often abbreviated as PTSD – or a lesser form known as Acute Stress Disorder.
What makes living with a stress disorder different than experiencing normal day to day stress? Simply put, many tress disorders are diagnosed in an individual after they experience a trauma, and therefore a lot of their stress becomes triggers for other things that may affect their lives and make different tasks nearly impossible to complete.
First Things First
When the individual begins to feel different, “off”, easily upset or if a loved one points out a change in the individual's emotions, behavior and demeanor after the traumatic event, these would be the first sign the the individual may want to make an appointment to speak with their doctor to get a diagnosis and develop a treatment plan. With Acute Stress Disorder, there are usually many options available as a treatment plan, but the main two are medications or cognitive behavioral therapy. At that time, it would the patient's choice of what route of treatment they would like to use. If the individual choose medications, then they have to have another discussion with their doctor to figure out what form and type of medication they would like to take based off of the doctors recommendation. The treatments can vary greatly as it would be dependent on the severity of the level of Acute Stress Disorder.
What Is Acute Stress Disorder?
Acute Stress Disorder – or abbreviated as ASD – is usually diagnosed after an individual has gone through or witnessed a traumatic or petrifying experience, such as a car accident, fire, shooting or assault. Acute Stress Disorder can even be diagnosed after an individual has been diagnosed with a life threatening disease, such as a terminal cancer that can not be treated. The individual has lived through the traumatic events or lived through receiving the terrifying news, of those individuals, an average of 5 to 20 percent (Acute Stress Disorder. 2019) of the individual's will end up diagnosed with Acute Stress Disorder due to the trauma.
The diagnosis of Acute Stress Disorder is often accompanied by the diagnosis of anxiety and depression – the three seem to dance hand in hand but with various factors and levels. An indiviaul is usually able to receive a diagnosis of Acute Stress Disorder as soon as three days after the individual began experiencing any of the symptoms that are caused by the body's natural stress hormones – such as epinephrine, adrenaline and cortisol. These hormones would have been triggered as the individual was experiencing the trauma.
The first symptoms that the individual may experience would include flashbacks to the trauma, nightmares, difficulty remembering the trauma, dissociation, difficulty concentrating, among many other possible symptoms. With these symptoms, also comes the symptomatic affects that come with depression and anxiety, such as restlessness, paranoia, heightened self awareness, a constant feeling of exhaustion and unable to find joy or energy in daily activities that used to be easy and enjoyable for the individual. The individual could also experience more physical symptoms such as chest pain, stomach pain, palpitations, difficulty breathing, headaches and nausea – though some individual's will experience different symptoms, it is not unusual for symptoms to start to affect the individual within minutes of the trauma that was experienced, but can also take days or weeks while the individual's adrenaline calms down allowing the body to feel other side effects.
What is PTSD?
Post Traumatic Stress Disorder is defined as a psychiatric disorder that is usually diagnosed in individuals who have witnessed or personally experienced a traumatic event, much like Acute Stress Disorder. Post Traumatic Stress Disorder often comes with the effects of having disturbing and realistic thoughts and feelings that the individual experienced during the initial traumatic event. The individuals who are diagnosed with Post Traumatic Stress Disorder may relive the trauma for the rest of their lives and possibly have more triggering events than someone who lives with Acute Stress Disorder, such as loud noises or someone bumping into them (Torres, F. 2020).
The main difference between Acute Stress Disorder and Post Traumatic Stress Disorder is within the symptoms. The symptoms of Post Traumatic Stress Disorder can usually be organized into four categories: avoidance, intrusion, change in cognition and mood and change in arousal. These symptoms will be experienced in various levels, but are often debilitating to the individual causing them to feel unable to perform daily activities or have a nervous response to the activities, such as if the individual has realistic flashback nightmares each night, the individual may become more nervous of sleeping in general. While society often ties the two together, Post Traumatic Stress Disorder is not just diagnosed in military personal, but in reality, an estimated 1 in 11 people will have a diagnosis of Post Traumatic Stress Disorder within their own lifetime, that is equivalent to around 3.5 percent of adults living in the United States will be diagnosed with Post Traumatic Stress Disorder every year (Torres, F. 2020).
Neurochemical Systems
It is theorized that if an individual is diagnosed with Acute Stress Disorder and chooses to not acknowledge the diagnosis or does not seek help through either a medication or counseling that the Acute Stress Disorder will progress into Post Traumatic Stress Disorder. The theory is based off of the fact that Acute Stress Disorder is a form of Post Traumatic Stress Disorder, which is also why there are many similarities to the two trauma stress disorders. The progression does not always happen, but it is possible for many individuals since they are both trauma based conditions which take a DSM 5 diagnostic (Lenferink, L. I., M. R., Kullberg, 2020).
Due to the similarities, it make it really important to pay attention to some of the differences in symptoms so the changes in the neurochemical system, along with the changes in the different regions of the individual's brain is detected and shows the progression of Acute Stress Disorder. These changes are pretty evident due to the effects will be seen when the individual is living with chronic stress, so it will be likely to see a trauma response in an individual who lives with a stress disorder compared to an individual who does not. The change in the individual's brain can become long term and affect how the individual's brain responds during times of high stress or future traumas. The regions of the brain that are effected the most are the amygdala, the hippocampus and the medial prefrontal cortex (Bremner J.D. 2006). In these changes, it is theorized that either an overabundance or an insufficiency of cortisol and norepinephrine are being transmitted through the brain and body of the individual. Cortisol and norepinephprine are the two neurochemical systems that play very important roles in an individual's stress and trauma response during heightened times.
Cortisol, which is created in the body's adrenal glands, is a steroid type hormone whose main job is regulating the majority of the processes that happen within the individual's body – such as the immune response and the body's metabolism. Cortisol also lends a huge helping hand to how the individual's body responds to stress and trauma, which is why it is important in diagnosis Acute Stress Disorder. Norepinephrine – which is the same as noradrenaline – is also created in the body's adrenal glands. Unlike cortisol, norepinephrine is a neurotransmitter that helps the individual's body send messages and important signals throughout the nerve endings within the body. Norepinephrine is responsible for the increase in an individual's heart rate and for the seemingly quickened speed of the blood that is pumping from the heart when the individual is experiencing stress or an increase in their adrenaline.
Is There Treatment?
To treat Acute Stress Disorder, or at least, put a stop in it from progressing into Post Traumatic Stress Disorder, the individual's primary care doctor will usually recommend one of three treatments: cognitive behavioral therapy, medications or mindfulness. Since the treatments do vary pending the severity of the level of the Acute Stress Disorder, the recommended treatment can also be based off of the goal that the individual has for themselves; whether they want help managing their Acute Stress Disorder during times where a triggering event is present or if the individual's main goal is to preent their Acute Stress Disorder from progressing into Post Traumatic Stress Disorder.
It is normal for the first recommendation from the doctor to be cognitive behavioral therapy – or CBT – which connect the individual with a mental health professional to work with. This is usually seen as the individual having sessions with a psychologist or counselor. Together the individual and professional will have a goal of creating and practicing coping mechanisms for the individual to use in times of heightened stress, experiencing flashbacks or is going through another traumatic event. This treatment is thought to give the individual tools to use so that their Acute Stress Disorder does not hold the reigns on the individual's life during heightened times by giving the individual tools to use to take back control and be able to work their own way through the stress and fear.
Mindfulness would likely be the second treatment to be suggested, especially if the individual already performs mindfulness techniques such as breathing techniques, yoga or other forms of meditation. Mindfulness is taking medication and breathing exercises and giving them a purpose of helping the individual feel better during heightened times. These would all be intervention based techniques formed around the goal of helping the individual manage their stress and anxiety on their own.
Medication would be the third recommendation, which would start by the individual consulting their primary care doctor about different antidepressants or anticonvulsants that their doctor would recommend and what the individual would feel comfortable taking after learning the side effects. The medication route could be more of a trial and error method as it is possible it may take some time to find the correct medication and dosage – if more than one dosage is offered, such as with Lexapro, and finding the correct combination for the individual and their case since each diagnosis of Acute Stress Disorder is different than the other.
The Medicated Side of ASD
If the individual decides that they want to go with a mediation based treatment plan, a discussion would happen between the individual and their doctor on what type of medication would be best for the individual's specific case: selective serotonin reuptake inhibitors – also known as SSRIs-, Benzodiazepines, Antidepressants, Propranolol, Morphine, Hydrocortisone or Docosahexaenoic Acid (Sauer, J., & Bhugra, D. 2001).
The individual choosing the pharmacotherapy route of treatment, the individual is looking into taking either a single medication or a mix of medications that have been previously tested and proved to either treat the symptoms of Acute Stress Disorder itself or, at minimum, put a stop to the escalation of the Acute Stress Disorder developing into Post Traumatic Stress Disorder. The trick would then be finding which pharmacotherapy that both the individual and the doctor feel would work in the individual's case (Friedman, M.J., & Sonis, J.H. 2020). This plan can be developed by some trial and error with the basis of what what seems to work best for the individual and what they feel most comfortable with – part of the treatment could also include the individual using a prescribed medication in hand with behavioral or psychological therapies.
So Many Medications, Who Has The Time
Selective serotonin reuptake inhibitors and other antidepressants, the most commonly prescribed example being medications such as Lexapro, are often the first form of pharmacotherapy that a doctor will recommend when reducing the chances of Acute Stress Disorder progressing into Post Traumatic Stress Disorder. Clinical trials have not proven any benefits in treating Acute Stress Disorder with SSRIs and have received mixed data and results with treatment using other forms of antidepressants. Even with the lack of proof in treatment, SSRIs are likely to be the first recommended medication due to the flexibility within the medications themselves due to being able to pair different medications with another and alter the dosage pending on the needs of the individual and what is most effective. This flexibility also leaves some room for adjustments in the treatments, such as starting at a lower dose of the medication and then increasing it as needed, and possibly vice versa as the individual learns other coping mechanisms that could cause them to not need the assist from medications. When an individual is taking antidepressants, the medication increases the reuptake of serotonin, while also assisting the individual's body in increasing how much serotonin and mirtazapine the body releases on its own (Day, L.T., & Jeanmonod, R.K. 2008).
Reuptake is the process that happens within the individual's brain that will affect how a neuron will retrieve a chemical that had not been retrieved by the previous neurons in the line, even though there is barely any space between neurons, things still get missed. After the chemical has been retrieved, the brain's neurons then send message like signals to each other by sending the retrieved chemical through one another, much like a message being sent through a telephone line from one home to another; the chemical going from one neuron to the next. Reuptake is a greatly important process since it allows the recycling and reuse of the brain's neurotransmitters while also working on balancing the population of the neurotransmitters and controls how long a signal and message is being passed through the brain and body's neurotransmitters.
Benzodiazepines- such as Valium – are usually prescribed if the anxiety that is holding hands with the Acute Stress Disorder, is the main stressor to the individual, instead of the depression or triggers. Benzodiazepines are prescribed to help with anxiety and sleeping problems, in most cases. Benzodiazepines are looked at medically as more of a sedative, sometimes the individual will even feel a hypnotic effect that will cause the individual to feel drowsy and unable to focus, when comared to other medications that doctors could prescribe. Benzodiazepines work to slow the individual's body's functions while also increasing the gamma amino butyric acid along with the effects that the GABA has on the individual's brain. As the benzodiazepines slow the body's functions, in turn, the central nervous system also slows down (Bryant, RA, Masterodomenico J, Felmingham KL. 2008).
Propranolol is a form of pharmacotherapy that has been shown to be more effective if used closer to the individual's exposure of their trauma. The theory behind using propranolol is to reduce any triggering and further trauma responses which would create the individual's brain to condition to the memories, causing the brain to be unable to create a condition response to any triggers that could potentially cause the Acute Stress Disorder to progress into Post Traumatic Stress Disorder. In short, the theory is that if the individual uses a propranolol, the chance of the escalation would be diminished (Sauer, J., & Bhugra, D. 2001). The path of using propanolol is more meant to be a short term relief since propranolol is a beta blocker which would change the reaction in the individual's body to nerve impulses. Propranolol is meant to slow the individual's heart rate, causing the heart to pump blood throughout the individual's body with each so that there is no “blood rushing” feeling that often is felt when an individual feels anxious during heightened times. This is an ideal form of treatment if the individual feels that they can manage their Acute Stress Disorder until faced with experiencing a trigger, such as long car rides or public speaking.
Morphine can also help an individual that has been through a traumatic experience due to morphine reducing the norepinephrine. Neroepinephrine increases the individual's heart rate and can cause the individual to feel a “blood rushing” feeling due to there being an increase in the blood that the individual's heart is trying to steadily pump throughout the body. Receiving a dose of morphine has been shown to reduce or at least slow down Post Traumatic Stress Disorder symptoms from being an initial concern right after the trauma, which gives the individual more time to receive help and develop a treatment plan to manage their Acute Stress Disorder before it progresses (Alder-nevo, G., & Manassis, K. 2005). The use of morphine has been seen to help ward off Post Traumatic Stress Disorder, randomized trials and testing has not been completed causing morphine to not be used as a treatment, but instead just as the first helping hand to help the individual's body reduce the pain that is being felt and helping give time before the brain conditions the pain to the traumatic event that was experienced.
Lithium, a mood stabilizer and commonly prescribed for individual's who live with manic depression, can be prescribed as a pairing with other medications to act as a booster, though can also be taken on its own. Lithium is not often prescribed for Acute Stress Disorder, but can be added to the medication cocktail if it is a severe case or the doctor and individual feel as if adding lithium is needed. When an individual takes lithium, their GABA neurotramission is boosted while the transmissions of other chemicals, such as dopamine, are slowed down and some even fully stopped. Lithium can also act as a dopamine receptor, increasing serotonin and decreasing the norepinphine. It is not uncommon for doctors to prescribe lithium as a last resort when working on a treatment plan for Acute Stress Disorder as lithium can cause a dependency along with lasting neurological effects on the individual who takes it.
What if Pharmacotherapy Does Not Feel Right
There seems to be an urgency for the individual to find a method that works for them to help manage, live with and cope with their Acute Stress Disorder before it progresses into Post Traumatic Stress Disorder, but in reality that is always time to change the form of treatment if the individual does not feel like medication, or any form of treatment they chose, is working for them. For some medications, different doses are available so if the individual likes the effects of the medications but feels like its too little or too much, the individual is able to speak with their doctor and adjust the dosage, or they can discuss changing the treatment plan all together (Pennington, J.G., & Guina, J. 2017).
The individual could possibly be advised to take a form of placebo or medication for the rest of their life in order to help them manage their Acute Stress Disorder, but just as with many diagnosis, there are always other options that can be looked into if the individual does not want to feel as if they are reliant on a medication for the rest of their days.Some natural remedies have been seen to help, such as Saint John's Wart when taken with Vitamin D. Medication and therapy are not the only options that an individual has as a treatment plan if that is not what they feel comfortable with, which is why it is important for the individual to speak openly about concerns, wants and what they do not want, with their doctors. Though developing a treatment plan seems as if it is time sensitive so that there is no progression or worsening of the Acute Stress Disorder diagnosis, it is important when an individual is dealing with a stress disorder, that the individual feel comfortable and confident in their treatment plans as it may be something that they use for the rest of their life.
Continue Living
Every person experiences stress, and those who live with a stress disorder possibly feel it more intensely, irrationally or more frequently but the good news is that in most cases its manageable and something that people can live with. The individual learns their new view on the world, possibly with assistance of medications or a mental health professional but the individual will learn to live with their Acute Stress Disorder along with the trauma that it came from, though it make take a lot of adjusting, time and patience from both the people in the individual's environment and, more importantly, the individual with themselves. This is a new world, things have changed without actually changing, and that is okay. Breathe, adjust and continue on.
Resources
Acute Stress Disorder. (2019, October 11). Retrieved August 10, 2020, from https://www.stress.org/acute-stress-disorder
Adler-nevo, G., & Manassis, K. (2005). Pharmacotherapy for Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in Children and Adolescents. Child & Adolescent Psychopharmacology News, 10(5), 1–8. https://doi-org.proxy- library.ashford.edu/10.1521/capn.2005.10.5.1
Bremner J. D. (2006). Traumatic stress: effects on the brain. Dialogues in clinical neuroscience, 8(4), 445–461.
Bryant, R. A. (2018). The Current Evidence for Acute Stress Disorder. Current Psychiatry Reports, 20(12), 111. https://doi-org.proxy-library.ashford.edu/10.1007/s11920-018-0976-x
Bryant RA, Mastrodomenico J, Felmingham KL, et al. Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry 2008; 65:659.
Dai, W., Liu, A., Kaminga, A. C., Deng, J., Lai, Z., Yang, J., & Wen, S. W. (2018). Prevalence of acute stress disorder among road traffic accident survivors: A meta-analysis. BMC Psychiatry, 18. https://doi-org.proxy-library.ashford.edu/10.1186/s12888-018-1769-9
Day, L. T., & Jeanmonod, R. K. (2008). Serotonin syndrome in a patient taking Lexapro and Flexeril: a case report. The American Journal of Emergency Medicine, 26(9), 1069.e1-3. https://doi- org.proxy-library.ashford.edu/10.1016/j.ajem.2008.03.028
Friedman, M. J., & Sonis, J. H. (2020). Pharmacotherapy for PTSD: What psychologists need to know. In L. F. Bufka, C. V. Wright, & R. W. Halfond (Eds.), Casebook to the APA Clinical Practice Guideline for the treatment of PTSD. (pp. 207–232). American Psychological Association. https://doi-org.proxy-library.ashford.edu/10.1037/0000196-010
Jones,
T. L. (2001). Definition of stress. Eating
disorders in women and children: Prevention, stress management, and
treatment,
89-100.
Lenferink, L. I. M., Egberts, M. R., Kullberg, M.-L., Meentken, M. G., Zimmermann, S., Mertens, Y. L., Schuurmans, A. A. T., Sadeh, Y., Kassam-Adams, N., & Krause-Utz, A. (2020). Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: Findings from an international data archive. European Journal of Psychotraumatology, 11(1). https://doi-org.proxy-library.ashford.edu/10.1080/20008198.2020.1717156
Masilamani, S., & Ruppelt, S. C. (2003). Escitalopram (Lexapro) for depression. American Family Physician, 68(11), 2235–2236.
Ophuis, R. H., Olij, B. F., Polinder, S., & Haagsma, J. A. (2018). Prevalence of post-traumatic stress disorder, acute stress disorder and depression following violence related injury treated at the emergency department: A systematic review. BMC Psychiatry, 18. https://doi-org.proxy- library.ashford.edu/10.1186/s12888-018-1890-9
Pennington, J. G., & Guina, J. (2017). Serotonergic Synergy in the Pharmacotherapy of Acute Posttraumatic Stress Disorder Exacerbation: A Case Report. Military Medicine, 182(1), e1673– e1677. https://doi-org.proxy-library.ashford.edu/10.7205/MILMED-D-15-00572
Sauer, J., & Bhugra, D. (2001). Drug treatments in post-traumatic stress disorder. International Review of Psychiatry, 13(3), 189–193. https://doi-org.proxy- library.ashford.edu/10.1080/09540260120074055
Torres, F. (2020). What is Posttraumatic Stress Disorder. American Psychiatric Association. Retrieved from: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Getting the Diagnosis
First thing's first when an individual is starting to feel funny, off, upset or someone points out a change in their emotions, behavior and demeanor after a traumatic event. They may decide to make a doctor's appointment and get a diagnosis and then discuss a treatment plan. With Acute Stress Disorder, there are many options as treatment plans but the main two are either medications or therapy. At this time, it is patient's choice of what route they want to take, if they choose medications, they then have another decision to make for what form and type of medication that they want to take, with doctor's recommendation, of course. The treatments can vary greatly pending on the severity of the Acute Stress Disorder and if the goal of the individual is to treat the Acute Stress Disorder, need help managing during times where a triggering event is happening or prevent their diagnosis from escalating into Post-traumatic Stress Disorder.
Pharmacotherapy: What are the Options?
After a patient has decided that they want to go with a medication treatment plan, a discussion will happen with their doctor on what type of medication would be best for this individual's case: selective serotonin reuptake inhibitors – also known as SSRIs -, Benzodiazepines, Antidepressants, Propranolol, Morphine, Hydrocortisone, or Docosahexaenoic Acid.
With choosing the pharmacotherapy route of treatment, the individual is looking into taking a single medication or a mix of medications that have been tested and proved to either treat symptoms of Acute Stress Disorder, or at least prolong the escalation of the Acute Stress Disorder developing into Post-traumatic Stress Disorder, now the trick is finding which pharmacotherapy that the patient and doctor feel would work in this case. This could be discovered by some trial and error based off of what seems to work best for the patient and what they are the most comfortable with – and part of the treatment could still include the patient using a prescribed medication in conjunction with behavioral and psychological therapies.
Let's Break Them Down
Selective serotonin reuptake inhibitors and other antidepressants -commonly prescribed example being Lexapro - are usually the first a doctor will look at as options when reducing the likelihood the Acute Stress Disorder escalating into Post-traumatic Stress Disorder, though clinical trials have not necessarily found any benefit in treating just Acute Stress Disorder with SSRIs and have had mixed results with treatment using other forms of antidepressants. The reason that this may be the first to method to be talked about is the flexibility in the medications, and also the ability to pair different medications with each other or alter the dose of some of the medications with the ability to make the dose less or more pending the need of the patient and what they feel they need. It also leaves room for the dose to start high but lessen as the patient learns different coping mechanism causing the need less in the form of a medication. When an individual is taking antidepressants, they increase the reuptake of serotonin, while also helping the individual's body increase how much serotonin and mirtazapine the body release.
The reuptake is a process that happens in the individual's brain that affects how a neuron will retrieve a chemical that was not retrieved by the previous neurons even though there is barely any space between the neurons. Once the chemical has been retrieved, the neurons then send signals to each other by sending the chemical through one another, like a message being transmitted in a telephone line from one home to another, the chemical going from one neuron to the next. Reuptake is a very important process as it permits the reuse of the brain's neurotransmitters while also balancing the population of the neurotransmitters, which in turn, also means that the reuptake process helps control how long a signal and message is being released by and received by the brain and body's neurotransmitter.
Benzodiazepines – common example being Valium - are often times more prescribed if the anxiety is the main stressor to the individual living with Acute Stress Disorder rather than depression or triggers, since benzodiazepines are mainly prescribed to help with anxiety and sleeping problems. Benzodiazepines are seen as more of a sedative -sometimes even seen as having a hypnotic effect on those who take it, causing the individual to feel drowsy and unable to focus - when compared to other medications that could be prescribed -, as benzodiazepines work to slow the body's functions while increasing the gamma amino butyric acid and the effects that the GABA has on the individual's brain. As the benzodiazepines slow the body's functions, the central nervous system also slows down.
Propranolol is a form of treatment that has been seen to be more effective if used closer to the exposure of the trauma. The theory behind this is to reduce any triggering and reactivating trauma responses that would create the brain to condition to the memories, the thought is that if the brain is not able to create a conditioned response to the trigger that the escalation from Acute Stress Disorder to Post-traumatic Stress Disorder would be diminished. This form of treatment is more for a short term relief as Propranolol is a beta blocker, therefore changing the reaction the individual's body has to nerve impulse. Propranolol slows down the individual's heart rate, causing the heart to pump blood around the individual's body with ease, this causes there's no “blood rushing” feeling that happens when the individual feels anxious during that moment in time. This would be an ideal treatment if the individual finds that they can manage their Acute Stress Disorder, except when experiencing a trigger such as public speaking or long car rides.
Morphine is usually used to control pain that has been endured or that the individual has been exposed to during the trauma, due to the reduction in norepinephrine. Norepinephrine, also referred to as a noradrenaline is a hormone that is created by the body's adrenal glands but is also a neurotransmitter. Norepinephrine increases the individual's heart rate and will cause the “blood rushing” feeling due to an increase in the blood that the individual's heart is pumping through the body. Receiving morphine has been linked to reduce or slow down the Post-traumatic Stress Disorder symptoms from being relevant right after the trauma, giving the individual more time to receive help to manage Acute Stress Disorder and not have it escalate. While the use of morphine has been seen to help deter Post-traumatic Stress Disorder, randomized trials and testing has not been fully completed therefore is not used as a treatment, but is still seen beneficial if the individual receives morphine after the initial trauma as the morphine helps the body reduce the pain that is being felt and will then cause the body to not feel the need to develop a conditioning to the pain or trauma that had been experienced by the individual.
Lithium, which is a mood stabilizer and is most commonly prescribed for individual's who live with manic depression. Lithium can be prescribed to be paired with other medications to act as a booster, though can also be taken on its own. Lithium is not often prescribed, but can be added to the medication regiment if it is a severe case or the doctor and patient feel as if it is needed. When taking lithium, the GABA neortransmission is boosted while the transmission of chemicals such as dopamine are slowed down or even stopped. Lithium can also act as a dopamine receptor, increasing serotonin and decreasing norepinephrine. Many doctors will use Lithium as a last resort when creating a treatment plan for Acute Stress Disorder as Lithium can cause a dependency with lasting effects on the patient taking it.
What if This Isn't Right?
While it seems like there is a short time to find a method that works for the individual to help manage, live with or cope with their Acute Stress Disorder in order to prevent it from progressing into Post-traumatic Stress Disorder, there is still time to change the form of treatment if the individual does not feel like the medication, or even form of treatment they chose, is working for them. For some medications, different doses are available so the individual could talk to their doctor and either get a higher or lower dose to see if that helps more or they can discuss changing the medication regiment all together.
In many cases, it is likely that an individual will be on some form of placebo or medication for the rest of their life in order to help manage their Acute Stress Disorder, but as with many diagnosis, there's other options that can be looked into if the individual does not want to feel reliant on a medication. Some natural remedies have been seen to help, such as Saint John's Wart when taken with Vitamin D. Medications and therapy are not the only options that an individual has as a treatment plan, which is why it is important for the individual to work with their doctor and speak about concerns, wants and what they do not want. While it may seem time sensitive, it is important when dealing with a stress disorder that is commonly trauma induced, for the individual to feel comfortable and confident in their treatment plan.
Living With the Diagnosis
Once an individual is diagnosed with Acute Stress Disorder, and finds the form of treatment that they feel comfortable with, it becomes just a matter of the individual learning their new view on the world. Some medications can cause them to react to events differently, or even feel a little light headed for a few days, and while the individual learns the effects that the medications will have on them and their lives, they are also learning to cope with their trauma and how that will be affected the rest of their life. Just as any new diagnosis an individual may get, learning to live with Acute Stress Disorder and the trauma it came from, may take some time and patience with both the people in the individual's environment, but more importantly, with themselves. This is a new world, thing have changed, and that is okay.
Adler-nevo, G., & Manassis, K. (2005). Pharmacotherapy for Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in Children and Adolescents. Child & Adolescent Psychopharmacology News, 10(5), 1–8. https://doi-org.proxy- library.ashford.edu/10.1521/capn.2005.10.5.1
Bryant RA, Mastrodomenico J, Felmingham KL, et al. Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry 2008; 65:659.
Day, L. T., & Jeanmonod, R. K. (2008). Serotonin syndrome in a patient taking Lexapro and Flexeril: a case report. The American Journal of Emergency Medicine, 26(9), 1069.e1-3. https://doi- org.proxy-library.ashford.edu/10.1016/j.ajem.2008.03.028
Friedman, M. J., & Sonis, J. H. (2020). Pharmacotherapy for PTSD: What psychologists need to know. In L. F. Bufka, C. V. Wright, & R. W. Halfond (Eds.), Casebook to the APA Clinical Practice Guideline for the treatment of PTSD. (pp. 207–232). American Psychological Association. https://doi-org.proxy-library.ashford.edu/10.1037/0000196-010
Masilamani, S., & Ruppelt, S. C. (2003). Escitalopram (Lexapro) for depression. American Family Physician, 68(11), 2235–2236.
Pennington, J. G., & Guina, J. (2017). Serotonergic Synergy in the Pharmacotherapy of Acute Posttraumatic Stress Disorder Exacerbation: A Case Report. Military Medicine, 182(1), e1673– e1677. https://doi-org.proxy-library.ashford.edu/10.7205/MILMED-D-15-00572
Sauer, J., & Bhugra, D. (2001). Drug treatments in post-traumatic stress disorder. International Review of Psychiatry, 13(3), 189–193. https://doi-org.proxy- library.ashford.edu/10.1080/09540260120074055
***** Disclaimer & Trigger Warning *****
This following blog is - in a roundabout way - about sex, so if you are not wanting to continue: don't.
(Mom and dad, leave now, please)
I will also be talking about some harassment, abuse, assault, and the hated "r" word - not in detail, but there's a pretty heavy paragraph with some example. So as I have said before if you aren't wanting to read this, that's okay. Take care of yourself. If this is still a topic that you want to talk about but do not want to read this, message me/comment and we will talk privately. Thank you.
So, let's start: I will not be talking about my experiences (except for one, because I feel like it is important) and I will not be using a timeline or names. I am typing this post because I had a question sent to me about what it is like having HSP and Acute Stress Disorder when it comes to having a sex life and while I can't say if it is different than "normal" people, I can say that it can be hard, even when it is all you've known.
I lost my virginity at 18/19 years old - while at college in Vegas because ya know... what happens there stays there? No, it is because I figured it would be a memorable thing, would help me feel better with my injury, and didn't really want to come back to Oregon still rocking the V-Card. It was a personal choice, there is nothing wrong with still holding your card, no matter your age, I just wanted to lose it to see what the big deal was.
There are different opinions on how I lost my V- Card though since it depends on each individual's definition of what counts - which is why I said 18/19.
See before my birthday (so, when I was 18), I had a friend on campus who had never been with a girl so we figured we could be each other's first, and it really not be a big deal. We knew it was going to be terrible so, let's just get it over with.
It's Just Stress
Emotional strain, tension, pressure... to put it simply: stress. Every human being and creature knows some form of stress, on all different levels. An infant gets stressed out when they are hungry, so they begin to cry. A teenager gets stressed out with trying to fit in, so they argue with their parents. Adults get stressed out so they possibly drink a glass of wine or opens a beer to go with their dinner. Every human being feels stress, but some individual's life with a form of a stress disorder such as post-traumatic stress disorder – often abbreviated as PTSD - or a lesser condition from the same family: acute stress disorder.
What is Acute Stress Disorder?
Acute stress disorder is often diagnosed in an individual after that person has experienced or has even witnessed a terrifying or traumatic event, such as assault, a car accident, fires, floods, or even being diagnosed with a different life threatening diagnosis, such as terminal cancer. While many people may live through these traumatic events or news, anywhere from 5 to 20 percent of people end up diagnosed with acute stress disorder after having experienced the trauma. The diagnosis of acute stress disorder usually includes a diagnosis of anxiety and depression, as well. It is possible to diagnose an individual with acute stress disorder as quickly as three days after the individual began experiencing any of the symptoms that are caused by stress hormones – such as epinephrine - that was triggered by the trauma experienced.
When looking at acute stress disorder, it is common to see similarities to post-traumatic stress disorder as they are in the same trauma stress disorder family for diagnosis and it is theorized that if acute stress disorder continues to affect the life of the individual, it will progress into PTSD. This does not always happen, but is not impossible as both are trauma based conditions and takes a DSM 5 diagnostic. This is where paying attention to some of the symptoms is important so that the acute stress disorder can be diagnosed early on before it possibly progresses into PTSD. Some of these symptoms could be chest pain, stomach pain, palpitations, experiencing difficulty breathing, unusual sweating, consistent headaches, and nausea – though some individual's will experience different symptoms, it is usual for symptoms to begin as quickly as minutes after the trauma occurred to a few days or weeks after the adrenaline has calmed down. It is also possible for individuals to experience more internal and psychological symptoms such as arousal, over arousal, avoidance, displacement or dissociation, intrusion -commonly as nightmares or flashbacks- and an overall negative or pessimistic mood.
To treat acute stress disorder or at minimum, stop it from progressing into PTSD, a doctor will usually recommend one of three treatments: cognitive behavioral therapy, mindfulness or medications. The first recommendation is usually going to be cognitive behavioral therapy – or CBT – which would involve the individual working with a mental health professional with the goal of creating and practicing coping mechanisms for the individual to use in times of high stress or while experiencing a flashback. This is often seen as the individual seeing a psychologist or counselor. Mindfulness may be the second recommendation if the individual feels like meditation and breathing exercises would be enough to help them feel better. These are all intervention techniques to help the individual manage their stress and anxiety. Medications would be the third recommendation, which would include the individual talking to their doctor about the different antidepressants or anticonvulsants the doctor recommends and what the individual feels comfortable taking. The medication route would be more trial and error as it takes time to find the right medication and get the right dosage – if more than one is offered, such as with Lexapro - for the individual.
What in the Neuroscience
With acute stress disorder being a stress disorder, it is easy to say that it causes changes in the neurochemical system as well as changes in different regions of the individual's brain. It is easy to say this, because these effects are seen when an individual is living with chronic stress, so it is likely to see the same response when the individual lives with a stress disorder. These changes can become long term and affect how the brain responds during times of high stress. The primarily important and more affected regions of the brain are the hippocampus, the amygdala and the medial prefrontal cortex . In these changes, it is theorized that either too much or not enough cortisol and norepinephprine are being transmitted through the brain and body of the individual. These are the two neurochemical systems that play very important roles in an individual's stress response during heightened times.
Cortisol is a steroid type hormone that is primarily responsible for regulating a mass majority of the processes that happen throughout an individual's body – such as the immune response and the body's metabolism. Cortisol also plays a huge helping hand in how the body responds to stress and trauma and is created in the body's adrenal glands. Norepinephrine – sometimes referred to as noradrenaline – is also created in the adrenal glands but is a neurotransmitter that helps the body send messages and signals across the nerve endings throughout the body. Norepinephrine is responsible for an increase in the individual's heart rate and for the blood pumping from the heart when the individual is experiencing stress or adrenaline.
Stress, What is it Good For?
While every person experiences stress, it does not make it more fun, just relate-able and easier for other individual's to empathize. Add an imbalance of cortisol and norepinephrine, and it becomes less likely for other individual's to really understand the extremity of the individual's experience and what they go through in their day to day lives while living with a stress disorder that has caused actual changes in their brain. The first step to living with acute stress disorder is noticing the signs and getting help. This can be the hardest for people who have lived through different traumas, but as with anything that involves the brain, we have to face it head on.
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