*SCHOOL PAPER* ASD Medications

 

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.

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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

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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

"Let's Talk About $3X, Baby"

 ***** 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. 

Well..... that proved to be a bit more difficult as he got a bit too nervous. 

So, we did just fool around and he had happened to have bought a *ehem* toy for the "special occasion" so that was used. 

Since there was penetration (bleh, hate that word), some people would consider that having been my first time. 

Kinda awkward and sucky.

Now, for actually having sex, it was after my birthday and right before I was moving back to Oregon. This will be the only person/experience I really kinda talk about since it was my "first" and I feel like it is a great example of how my HSP causes me to feel a connection and then makes it so I am unable to really let it go.

I ended up flirting with a guy who lived on my dorm floor who, I swear, every girl wanted a chance to be with.

(Let's just say I blushed and smiled anytime he and I were even in the same room. 

Eye contact? Forget about it!)

I definitely knew his name, but I was surprised he knew mine. After a night that is a story in itself, he and I exchanged numbers and in one of our conversations, I had told him that I wanted to sleep with someone from Vegas before I left - hinting, of course, while still in shock of who I was texting. Next thing I knew, we were setting something up.

(Though, after him and I hooked up... due to a mutual friend, everything got SUPER embarrassing in the days that followed. I couldn't wait to get out of the dorms. I did literally everything I could to avoid running into him before I left - including taking the stairs in my ankle book rather than taking the elevator.)

 While I'm not going to talk about what happened, I want to explain something about this experience. No, he and I were not dating. Like I said, I was shocked he even knew my name. We had only hung out maybe a handful of times before, and always with other people. I thought he was insanely attractive, and I thought I had never even caught his eye. So, why him? Because for some reason, though I barely knew him, I felt like I could still trust him with my life. There was instantly something there for some reason for me. I knew I wouldn't regret anything and that I'd be safe, and okay. Something about him made my HSP calm down, and to this day, I'm not sure I can explain it.

Now, here is why I felt like this was important:

I never let go of that connection or how calm he made me feel.

 While he and I were not together or had even dated, and I really wasn't sure if he even knew my name... there was a connection. It might have just been on my side, and I had no idea about his feeling or anything like that because I was too shy and nervous to ask. I wasn't going to tell him it had been my first time - though I'm sure he knew - and I didn't want to seem like that clingy "we slept together so now I love you" type of girl, especially since I was moving back to Oregon and what I felt at the time wasn't love. We were young, I barely knew him... how was I supposed to explain that I felt like there was something between us without there actually being anything between us?

Anyway, as I said, I never let go of that connection. I don't know if it was because he was my first or if it was something else, but since that day, I would find myself thinking of him and kind of missing him or at least missing talking to him. I would see him again when I went back to Vegas for my 21st, and from the minute I saw him until he dropped me back off at my friend's house where I was staying... I couldn't stop smiling.

So, why was it important for me to talk about this one time while I'm not really going to delve into the rest?

Because, at that time, I did not have my anxiety. I had my hypersensitivity and had just gone through a lot mentally and emotionally trying times on my own. I lost my virginity to someone I barely knew, but for some reason would have literally trusted with my entire life and that's perfectly okay. We were not in love, we weren't exactly friends and all of that was okay. But my HSP did come in to play due to the fact that even 2 years later when I saw him again, I still felt that connection. When he would text me after my 21st, because he had moved to Reno, I would feel that connection and seriously contemplate driving to Reno just to see him.  I know everyone says that they remember their first time and that the person will always have a part of you. But because of my HSP, it was more intense due to the instantaneous feelings from nothing to something while also not understanding a single lick of it. 

(Insert embarrassment here, as I suspect he is one of the people who read these every once in a while and I've never fully told him all of that... welp, there it is.) 

(If you want to skip the TW parts: skip this!)

But, moving on since the question wasn't just about my first time:

When I had moved back to Oregon, I had a few different experiences. Some were great, others were not. I had a period of time in my life where sex meant nothing but was a way to get an attractive guy's attention.

Terrible, I know. 

Definitely not my proudest moments.

It got to the point where sex meant so little to me past just getting a guy's attention that I was emotionally hurting because I felt like I wasn't good enough for anything else.

"Pretty enough to bang, not good enough for a relationship or to even introduce to mom" 

is what I would find myself saying. 

I went through a few times of being forced or persuaded into having sex, even after having said no. I had been told that if I didn't sleep with the guy I was dating, that he was going to go kill himself. I had been told that the guy was different and wasn't going to use me, but I woke up later that same week to find his relationship status updated on Facebook to "in a relationship" with someone else. I had been taken advantage of after drinking. I had someone who I thought loved me, tell me I wasn't good at certain things, that I wasn't pretty enough for certain positions and that I should just lay there since that's all I was good at. I had a guy continue after I have said "stop, it hurts". I had a guy pout because I had said: "no not tonight". I had been sexually harassed and assaulted after continuously saying no. I had been in a situation where a guy was in the process of raping me as I woke up after taking medications. I have been held down and not been given an option to say no. 

With all of that, you can imagine how my emotions were:

self-conscious, no confidence, disappointed in myself and hated myself

By this time, some of those experiences were after my diagnosis with my Acute Stress Disorder, so then my anxiety would play in of not being good enough, them not actually wanting me...

Every hurtful word I could say or think to and about myself, was playing on constant repeat in my head.

(You are now past the TW stuff)

As I got older and got more confidence in myself and in my body, I started having more positive sexual experiences.
I learned more about myself sexually, including likes, dislikes, and some kinks. I played around, researched and it made me even more confident in myself. I felt great. 

But with that, my HSP still plays a huge part and so here is a majority of my answer to the question:

With having a sex life, aftercare is incredibly important. Aftercare is the time after sex where the partners check in with one another - sometimes referred to as pillow talk - and acknowledge the other's needs. It is also a time for each person to listen to their own bodies (including emotionally and mentally) and fulfill their bodies' needs.

 Both having an aftercare ritual with your partner and having self aftercare. Emotional and mental drops are incredibly common, where your mood and mentality just plummet down and it almost feels like depression kicks in. 

These times really suck. 

They are very often talked about in a more kink community (usually referred to as sub drops or dom drops, pending the dynamic) but can happen to those who don't necessarily go through "scenes" as well - as in my case.  

With my emotional state and mentality being what it is, the time after sex is almost more important than the sex itself. My aftercare with a partner is mainly personal touch 

(cuddles, showering together, holding hands, rubbing my back, playing with my hair, fidgeting with me) and affirmation

 (not as in a "good game" type, but a reminder that I matter to the person. That they care about me/love me. Even just a "you're pretty"). 

These come from my HSP due to needing the positive reinforcement and being in an almost permanent state of being touch starved. 

My personal aftercare is usually writing, taking a bath and eating/drinking whatever my body is wanting. My personal aftercare is simply listening to my body. 

Now, not everyone experiences a drop right way - it is rare that I do, and if I do then I wasn't in the right place mentally or emotionally to have had the experience, to begin with. Commonly, my drops happen 2 to 3 days after and seems to really only be if my aftercare needs weren't fully met by my partner, for whatever reason. My mind triggers and wonders if I'm going back to sex not meaning anything or leaving a way for any form of abuse to happen again. I start to internalize everything which really hurts and isn't good for my Acute Stress Disorder. If my aftercare needs are met - then I will not experience a drop. 

So, to lay it out simply: 

My HSP and Acute Stress Disorder affect my sex life because it has made aftercare a huge need in my life. Knowing that the person cares about me because I refuse to go back to the abuse is one of the most important thing to me. I know the question was asked because the curiosity was probably if my HSP makes orgasms feel better or if my Acute Stress Disorder made it so I can't have sex in certain areas or the like. The answers to that are no. I have never known sex without my HSP so I don't know what an orgasm would feel like without it, and my Acute Stress Disorder only affects my sex life when I get triggered of my past abuse.

 If that happens, it causes me to shut down completely. 

I become quiet, avoid contact of any sort - touch, eye contact, anything that causes a connection. I will begin to fidget with something in an anxious way (usually a fidget toy or a hairband I keep on me). I'll say whatever I can to get out of the situation. 

Another thing I have gotten asked when it comes to my HSP and sex: no, I do not instantly feel a connection with everyone I have had a sexual experience with. 

In fact, having a sexual experience with some of the guys I have been with is what broke us up because there was no chemistry or connection at all once the clothes were off and I can talk about what it's like to lose a connection with someone in a different post 

(my HSP does make that kind of interesting). 

My HSP does not make me fall in love with every guy I get in bed with, nor does it make me cling to them, feel a connection with them or become needy to them. Yes, in some cases, one or more of these has happened but maybe only a handful of times.

(I can only think of 4 times that this was true - one obviously being my first, which is another reason why I thought it was important to talk about so that I had an example of how I am not really able to let those connections go, especially if the person is still a huge part of my life.)

The other thing to remember, since I've grown and learned, sex is only happening when I want it to. Therefore, my HSP is more on the positive side and my Acute Stress Disorder wouldn't be triggered. Though, is why aftercare is important. To keep everything on the positive side and avoiding the drop that causes my HSP and Acute Stress Disorder to become hyperactive. 

Hopefully, that answers the question without being too detailed and awkward? I don't know. I feel like I was driving around a round-about after talking about my first experience... so if there are more questions about any of this, please let me know! I've seen such an increase in my readers here, and I promise, I read through every message I get and make notes of the questions I get asked. Sometimes, it just takes me a bit to figure out how I'm going to answer. 

Until I can think of a way to make it make more sense;

*SCHOOL PAPER* Acute Stress Disorder

 

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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