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Wednesday, January 30, 2013

Buddhism as a Therapy and Psychiatric Medications

Question: I believe I am going to be prescribed medication for PTSD and Depression at my next appointment and I am really nervous. If you were to prescribe medication to me for those conditions, what would you choose and why?

Answer: After seeing thousands of clients over the past 18 years, I have developed a prescribing style that targets your symptoms and not your diagnosis.  I am not a big fan of the diagnostic system in psychiatry today, but I realize we need to use it for insurance reimbursement purposes. That being said, what medications I would prescribe for you would depend solely on your most bothersome symptoms. And, sometimes I recomend therapy only. If your PTSD symptoms include nightmares that cause you insomnia and that leads to anxiety and depression, I would want to minimize your nightmares with prazosin. If your main symptom was irritability and anger, I might prescribe you prozac or seroquel. If your main symptoms are anxiety and panic, I might prescribe you zoloft or celexa or lexapro. If your main symptoms are depression and sadness, I might prescribe prozac, or celexa, or lexapro.  With PTSD though, therapy seems to work best. For people with a history of trauma, reducing anxiety may seem scary because our anxiety keeps us alert for possible attack...so with Buddhism and CBT, we can feel safer with mindfulness and virtue. It takes work and it's not as easy as swallowing a pill! To practice virtue in a Buddhist way, with a therapist who believes like I do, you can eventually regulate your actions, words, and thoughts to create benefits rather than harm...benefits for yourself and for others. You got through the trauma, you are still here, and many people love you. You are strong. You have a right to be strong and strength helps you do good things.  So maybe you need medication while you work through therapy...and that's ok.