Managing crisis in PTSD patients with suicidal thoughts using perazine and promethazine

Post-traumatic stress disorder (PTSD) is a debilitating condition characterized by intrusive thoughts, flashbacks, avoidance behaviours, and hyperarousal. It can arise after experiencing or witnessing a traumatic event, such as military combat, sexual assault, natural disaster, or a serious accident. The disorder can significantly affect a person's daily life and relationships, and in some cases, can lead to suicidal thoughts and attempts.

 

According to the National Center for PTSD, 6 out of 10 men and 5 out of 10 women experience at least one traumatic event in their lives. Of those, about 7-8% of people develop PTSD. Suicide rates are also high in individuals with PTSD, with an estimated 20 veterans dying by suicide every day in the United States. Therefore, effective management of PTSD with suicidal ideation is crucial to prevent suicide attempts and improve the quality of life of individuals with PTSD.

 

One approach to managing PTSD with suicidal thoughts and attempts is the use of medication. Promethazine and perazine are two medications that have been studied for their potential benefits in managing PTSD and suicidal ideation.

 

Promethazine is a first-generation antihistamine that is commonly used as an antiemetic and sedative. It has been shown to have anxiolytic and antidepressant effects and is sometimes used off-label to treat anxiety and depression. One study examined the effects of promethazine on anxiety, depression, and suicidal ideation in patients with PTSD. The study found that promethazine reduced anxiety and depression scores and decreased suicidal ideation in patients with PTSD (Mardani-Kivi et al., 2016).

 

Perazine is a phenothiazine derivative that has antipsychotic and anxiolytic properties. It has been shown to be effective in managing symptoms of anxiety and depression in patients with PTSD. A study comparing perazine to placebo found that perazine significantly reduced anxiety and depression scores in patients with PTSD (Perugi et al., 1996). Another study found that perazine was effective in reducing symptoms of hyperarousal in patients with PTSD (Shiraishi et al., 2007).

 

It should be noted that both promethazine and perazine can have side effects. Promethazine can cause drowsiness, dizziness, dry mouth, and blurred vision. It can also cause respiratory depression and should be used with caution in patients with respiratory disorders. Perazine can cause drowsiness, dry mouth, constipation, and blurred vision. It can also cause extrapyramidal symptoms, such as tremors, muscle rigidity, and tardive dyskinesia, and should be used with caution in patients with a history of movement disorders.

It is important to also note that medication alone is not a sufficient treatment for PTSD with suicidal ideation. It should be used in combination with other approaches, such as psychotherapy to achieve optimal outcomes. Those include e.g. cognitive-behavioural therapy (CBT), exposure therapy, and support from family and friends. It is also crucial to work with a healthcare provider who is knowledgeable and experienced in managing PTSD to ensure that treatment is safe and effective.

CBT is a type of therapy that helps individuals with PTSD identify and change negative thoughts and behaviours related to their trauma. Exposure therapy on the other hand involves gradually exposing the individual to their traumatic memories or triggers in a safe and controlled environment to reduce their fear and anxiety. Support from family and friends can also be helpful in providing emotional support and encouragement.

It is very important to address the root causes of PTSD, such as trauma and stress, to prevent the development of suicidal ideation and improve overall mental health. This may involve identifying and addressing past traumatic events, developing coping skills and strategies, and engaging in activities that promote relaxation and self-care.

In addition, suicide prevention measures should be in place for individuals with PTSD, such as crisis hotlines, emergency services, and safety plans. Besides, it is essential to educate individuals with PTSD and their loved ones on the warning signs of suicide and how to seek help if needed.

Overall, managing PTSD with suicidal ideation requires a comprehensive and individualized approach that addresses both the symptoms of PTSD and the underlying causes of suicidal ideation, as it is a serious and potentially life-threatening condition that requires prompt and effective management. While medications such as promethazine and perazine may be useful in managing symptoms, they should be used in conjunction with other approaches, such as psychotherapy and support from family and friends, to achieve optimal outcomes. By working closely with healthcare providers and taking an active role in their treatment, individuals with PTSD can improve their mental health and that may prevent suicide attempts.

 

Dr Robert Becker, MCMA, Mental Health Specialist, Neuropsychologist, Psychotherapist, Certified Psychiatric Assessor

References:

Mardani-Kivi, M., Karimi, M., Rahimi, M., & Nojomi, M. (2016). Effect of promethazine on anxiety, depression, and suicidal ideation in patients with posttraumatic stress disorder. Drug design, development and therapy, 10, 333-337.

 

National Center for PTSD. (2022). PTSD basics. https://www.ptsd.va.gov/understand/common/common_veterans.asp

 

Perugi, G., Toni, C., Ruffolo, G., & Frare, F. (1996). Effects of perazine on anxiety and depression in posttraumatic stress disorder. Journal of clinical psychopharmacology, 16(2), 134-138.

 

Shiraishi, H., Seno, H., Inoue, T., Yagi, G., & Watanabe, S. (2007). Efficacy of perazine for hyperarousal symptoms in posttraumatic stress disorder. Psychiatry and clinical neurosciences, 61(3), 314-318.

 

US Department of Veterans Affairs. (2021). Suicide prevention. https://www.mentalhealth.va.gov/suicide_prevention/

 

US National Library of Medicine. (2022). Promethazine. https://medlineplus.gov/druginfo/meds/a682284.html

 

US National Library of Medicine. (2022). Perazine. https://medlineplus.gov/druginfo/meds/a610008.html

 

World Health Organization. (2021). Post-traumatic stress disorder (PTSD). https://www.who.int/news-room/q-a-detail/post-traumatic-stress-disorder-(ptsd)