Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets the unique needs of the survivor. The main treatments for people with PTSD are psychotherapy ("talk" therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. PTSD-specific-treatment begins only when the survivor is safely removed from the crisis situation. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.
Other strategies for treatment include:
• Educating trauma survivors and their families about how persons get PTSD, how PTSD affects survivors and their loved ones, and other problems commonly associated with PTSD symptoms. Understanding that PTSD is a medically recognized anxiety disorder is essential for effective treatment. • Exposure to the event via imagery allows the survivor to re-experience the event in a safe, controlled environment. A professional can carefully examine reactions and beliefs in relation to that event. • Examining and resolving strong feelings such as shame, anger, or guilt, which are common among survivors of trauma. • Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but new coping skills can make them more manageable.
The U.S. Food and Drug Administration (FDA) has approved two medications for treating adults with PTSD, sertraline (Zoloft) and paroxetine (Paxil) which are selective serotonin reuptake inhibitors (SSRIs). Both of these medications are antidepressants, which are also used to treat depression. They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Taking these medications may make it easier to go through psychotherapy. If an antidepressant is prescribed, it will need to be taken for several weeks before symptoms start to fade. It is important not to get discouraged and stop taking these medications before they've had a chance to work. An adjustment in dosage or a switch to another SSRI will usually correct problems. It is important to discuss side effects with your doctor.
Sometimes people taking these medications have side effects. The effects can be annoying, but they usually go away. However, medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately.
The most common side effects of antidepressants like sertraline and paroxetine are:
• Headache, which usually goes away within a few days. • Nausea (feeling sick to your stomach), which usually goes away within a few days. • Sleeplessness or drowsiness, which may occur during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects. • Agitation (feeling jittery). • Sexual problems, which can affect both men and women, including reduced sex drive, and problems having and enjoying sex.
There are other types of medications which doctors may also prescribe, such as the following ones. There is little information on how well these work for people with PTSD. Benzodiazepines may be given to help people relax and sleep. People who take benzodiazepines may have memory problems or become dependent on the medication. Antipsychotics are usually given to people with other mental disorders, like schizophrenia. People who take antipsychotics may gain weight and have a higher chance of getting heart disease and diabetes. Other antidepressants like fluoxetine (Prozac) and citalopram (Celexa) can help people with PTSD feel less tense or sad. For people with PTSD who also have other anxiety disorders or depression, antidepressants may be useful in reducing symptoms of these co-occurring illnesses.
Similarly, antidepressant medications called tricyclics are given at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. They are as effective as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause dizziness, dry mouth, drowsiness, and weight gain.
Psychotherapy is "talk" therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person's needs.
One helpful therapy is called cognitive behavioral therapy, or CBT. There are several parts to CBT, including:
• Exposure therapy: This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings. • Cognitive restructuring: This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way. • Stress inoculation training: This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.
Other types of treatment can also help people with PTSD. People with PTSD should talk about all treatment options with their therapist.
Talk therapies teach people helpful ways to react to frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:
• Teach about trauma and its effects. • Use relaxation and anger control skills. • Provide tips for better sleep, diet, and exercise habits. • Help people identify and deal with guilt, shame, and other feelings about the event. • Focus on changing how people react to their PTSD symptoms. For example, therapy helps people visit places and people that are reminders of the trauma.
Eye movement desensitization and reprocessing (EMDR) is a relatively new treatment of traumatic memories that involves elements of exposure therapy and cognitive behavioral therapy, combined with techniques (sounds, eye movements, hand taps) that create an alteration of attention. There is some evidence that the therapeutic element unique to EMDR, attentional alteration, may be helpful in accessing and processing traumatic material.