“Mom, I’m Taking Medication for PTSD"

As a sophomore in high school, Greta had survived a school shooting in which three of her classmates died. She had trouble sleeping and focusing during the 3 months after the event and saw a therapist who helped her restore her sleep and concentration. She did well, until she started her first year of medical school, when she felt a high level of stress. Going into large lecture halls led her to feel unsafe and look for exits everywhere, in case she had to escape from a shooter.

Sometimes she had a panic attack in large classes and had to leave. When there was a shooting at a different university, she had trouble sleeping every night, wondering if a shooter would enter her school. She started to have nightmares most nights about the shooting. She went to a therapist and then psychiatrist when her symptoms became unmanageable. She called her mother to tell her, “Mom, I’m taking medication for PTSD.”

During the first few weeks of freshman year, Liz went to a bar with friends. She met another freshman, and he invited her back to his room to talk. When she got to his room, he sexually assaulted her and then told her to leave. She was in shock. She had learned about preventing sexual assault, her parents had warned her, and now it happened. She told no one except a nurse practitioner at the student health care center who tested her for STDs. After this event she had trouble falling asleep.

She was tired all the time and on edge during the day, sometimes not going to class as she worried about running into the student who had assaulted her. When she went to class or she studied, it was hard to focus. She had always been a stellar student but got all Cs that semester. She reached out to a counselor the next semester and received help.

Both Greta and Liz are experiencing symptoms of Post-traumatic Stress Disorder or PTSD. According to the DSM V, PTSD involves exposure to death or threatened death, serious injury, or sexual violence by either directly experiencing the event, witnessing the event, or learning the event occurred to a friend or family member. Symptoms last for at least 1 month and include intrusive symptoms such as distressing memories, dreams, or flashbacks. Avoidance behaviors like not wanting to leave the house occur to prevent memories of the event. A negative mood and thinking may persist. Irritability, problems with concentration, and a sleep disturbance may also be present. Usually, these symptoms occur soon after the event, as they did with Greta and Liz, and they can also occur years later, as they did with Greta.

Not everyone experiences PTSD after a traumatic event. Studies show 8-12% of people exposed to trauma go on to develop PTSD. In my work with university students, I have seen an increasing number of students with PTSD. According to the National College Health Association survey, rates of students diagnosed with PTSD at some point in their lives increased from 4.8% in the fall 2019 to 8.2% in the spring of 2024. Rates of PTSD are higher in women than in men. There are many causes of PTSD in the university population – sexual assault, school shootings, military service, and childhood abuse. There are well-studied and effective treatments for PTSD.

Therapy for PTSD

Therapy is an excellent treatment for PTSD. The therapies that have been studied and proven effective include Prolonged Exposure (PE); Eye Movement and Desensitization and Reprocessing (EMDR); and Cognitive Processing Therapy (CPT). All these methods help people process their trauma and relieve the PTSD symptoms.

Medications for PTSD

While therapy can prove highly effective for the treatment of PTSD, medication may be considered for treatment as well. The selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine are FDA approved for the treatment of PTSD. The serotonin norepinephrine reuptake inhibitor venlafaxine has also shown efficacy for the treatment of PTSD. When a patient starts these medications, the dose should be raised slowly to reduce the chance of side effects. If it is clinically appropriate for medication treatment to end, it is important to taper the medication slowly. Medication treatment does not have to be forever, but it can be essential in helping patients recover during a difficult time.

Sleep problems are especially common in PTSD. If therapy is not effective for improving sleep, there are medications that can help. The sleep problems may resolve with an SSRI alone or with the addition of a medication at night like trazodone (an off-label treatment for sleep) or prazosin (an off-label sleep treatment for PTSD associated nightmares). I generally try to avoid the use of benzodiazepines like alprazolam and lorazepam or sleep agents like zolpidem, as they can be more difficult for patients to stop.

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Students who are in a relationship that involves ongoing abuse or interpersonal violence (IPV) face special challenges. Due to chronic verbal, physical, and/or sexual abuse, these students may experience PTSD as well as depression and anxiety. It is important to provide treatment to these patients through therapy and/or medication. A victim advocate affiliated with a campus or community police department can link them with legal and supportive resources to maintain their safety.

With greater recognition of the impact of trauma on mental health, treatments will continue to evolve. Parents, friends, therapists, and psychiatrists can all help students in their journey of healing from trauma.

©2025 Marcia Morris

Details have been altered to protect patient privacy.