Bruce Dow, M.D.

Stimulants and PTSD

A recent editorial by Richard A. Friedman, MD, in the NY Sunday Times for 4/22/12, raises the issue of stimulant use possibly exacerbating PTSD symptoms in US soldiers in Iraq and Afghanistan. This is an important issue for the US military, and for our civilian population as well. Many US college students use stimulants to stay awake while studying for exams and writing papers late at night. College students and other US civilians are at risk for PTSD from interpersonal violence, vehicular accidents, and a variety of natural phenomena, including fire, flood, wind storm, earthquake, etc. Excessive stimulant use may increase their risk of developing PTSD from trauma.

The incidence of PTSD in returning US veterans of the Iraq and/or Afghanistan wars is about 14%. The lifetime prevalence of PTSD in US civilians is 10% for women and 5% for men. Are these numbers being increased by the use of stimulants in our young people, both military and civilian?

Are US doctors prescribing excessive amounts of stimulants such as Ritalin and Dexadrine, and their long-acting counterparts, Concerta and Adderall? Coffee, caffeinated soda (Coke, Pepsi, Dr. Pepper), energy drinks (Red Bull), and activating antihistamines (Sudafed, Actifed) may contribute as well to our possible national stimulant overuse.

It is important that we stay awake during the day, especially while operating machinery (including automobiles). It is equally important that we get adequate sleep at night. We need at least six hours, and probably not more than eight hours per night. This should be natural sleep, not induced by sleeping pills (Ambien, Lunesta), benzodiazepines (Ativan, Klonopin), or alcohol.

How do we get good natural sleep? Regular sleeping hours are important: going to bed by midnight, getting up by eight AM. Quiet is important; a steady background noise (“white noise”) can be helpful if noise is unavoidable. Temperature is important, neither too hot nor too cold.

Exercise can be helpful in making us weary and ready for sleep. Letting go of stressful issues can be helpful, through reading, meditation, closeness with loved ones. Television and/or the internet are not particularly conducive to sleep, because of their fragmented and unexpected (sometimes violent) content, as well as their visual flicker.

So the goal is to live as naturally as possible within the seasonal day/night cycle, using as few stimulants (uppers) and as few soporifics (downers) as possible. This will help us deal more effectively with the various stresses and traumas that we may encounter during our waking lives. The military is obviously a special situation, where a certain level of stimulant use may be necessary, even life-preserving, but it is important to recognize that excessive use of stimulants may increase the risk of developing PTSD after a trauma.