Post-Traumatic Stress Disorder (Treatments)

A number of medications that were originally approved for depression have been found effective in healing posttraumatic stress disorder. 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.

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. These medications act in the brain on a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older antidepressants. While some patients report feeling slightly nauseated or jittery when taking SSRIs, symptoms disappear with time. Some people also experience sexual dysfunction when using some of these medications. An adjustment in dosage or a switch to another SSRI will usually correct problems. It is important to discuss side effects with your doctor.

Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs commonly prescribed for PTSD. These medications are given at a low dose and gradually increased until they reach a therapeutic level.

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

Cognitive-behavioral therapy (CBT) works to change emotions, thoughts, and behaviors. Exposure therapy is one form of CBT unique to trauma treatment—this uses careful, repeated, detailed imagining of the trauma in a safe, controlled context. In some cases, trauma memories or reminders can be confronted all at once (flooding). And in other cases, it is preferable to work gradually up to the most severe trauma by using relaxation techniques and by taking the trauma one piece at a time (desensitization).

Along with exposure, CBT includes learning skills for coping with anxiety (for example, breathing retraining or biofeedback) and negative thoughts (cognitive restructuring), managing anger, preparing for stress reactions (stress innoculation), handling future trauma symptoms, as well as addressing urges to use alcohol or drugs (relapse prevention), and communicating and relating effectively with people (social skills or marital therapy).

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.

Group treatment is an ideal therapeutic setting because trauma survivors are able to risk sharing traumatic material in a safe environment. As group members achieve greater understanding and resolution of their trauma, they often feel more confident and able to trust. As they discuss and share trauma-related shame, guilt, fear, rage, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past. Telling one's story and directly facing the grief, guilt, and anxiety related to trauma enables many survivors to cope with their symptoms, memories, and other aspects of life.

Brief psychodynamic psychotherapy focuses on the emotional conflicts caused by the traumatic event, particularly in relation to early life experiences. Through the retelling of the traumatic event to a calm and empathic counselor, the survivor achieves a greater sense of self-esteem, develops effective ways of thinking and coping, and more successfully deals with the intense emotions that emerge during therapy. The therapist helps the survivor identify current life situations that set off traumatic memories and worsen PTSD symptoms.