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.
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