Post-Traumatic Stress Disorder

What is post-traumatic stress disorder (PTSD)?

It is normal to be shocked or very scared when your life is in danger or if you watch something horrible happen. This type of event is called a trauma. If it causes you to have troubling symptoms that last longer than a month, you may have post-traumatic stress disorder (PTSD).

PTSD can make you feel so fearful or uneasy that it is hard to live your life. The symptoms may start soon after the traumatic event, or you may not have them until months or years later.

Soldiers who have been in battle often get PTSD. It is sometimes called combat fatigue or shell shock. But many other people also get PTSD. Living through a terrible experience like rape, child abuse, a serious accident, or a natural disaster makes you more likely to get PTSD.

PTSD can happen to strong, healthy people. It is not a sign of weakness. And it is not weak to admit you have a problem and ask for help.

What are the symptoms?

PTSD can make you:

• Have nightmares or very vivid memories (flashbacks) of the trauma. You may feel like it is happening all over again.
• Avoid places or things that remind you of what happened.
• Be unable to recall or talk about what happened.
• Feel numb or lose interest in things you used to care about.
• Feel jittery or grumpy.
• Have trouble sleeping or keeping your mind on one thing.

Sometimes people with PTSD have other symptoms. They may be very sad or depressed, or they may feel angry or guilty. Children with PTSD may behave badly or play-act the event over and over.

Symptoms may last only a few months, or they may come and go over many years. Sometimes they don't start until months or years after a trauma. PTSD symptoms can be so bad that they get in the way of work and personal life.

Some people try to handle their symptoms by pulling away from other people, working all the time, or using drugs or alcohol. This can lead to other problems, such as depression, substance abuse problems, and panic attacks.

What causes PTSD?

Everyone with PTSD has lived through an event that caused strong feelings of fear, helplessness, or horror. But not everyone who has such an experience gets PTSD. How likely you are to get PTSD depends on:

• How intense the trauma was.
• How close you were to what was happening.
• How strong your reaction was.

Your chances of getting PTSD are higher if you have a family history of depression or if you have been abused or lived through trauma in the past.

How is PTSD diagnosed?

Your doctor will ask detailed questions to find the cause of your symptoms and how severe they are. Your doctor will ask other questions to see how you are feeling and check how well you think, reason, and remember. He or she may also want to talk to close family members about your symptoms or behaviors.

You may also have a physical exam and lab tests such as blood and urine tests. These can help rule out other things that could be causing your symptoms.

How is it treated?

Counseling, sometimes called talk therapy, is usually the first step in treating PTSD. A type of counseling called cognitive-behavioral therapy is considered the best treatment for PTSD. It can help you understand and change your thoughts.

It can be very hard to talk about a traumatic event. So it is important to find a doctor and counselor you trust and feel comfortable talking to.

Your doctor may also prescribe antidepressant medicines. They can help you feel less sad and worried and help you sleep.

You may need treatment for 3 to 6 months. In some cases, treatment may last longer.

Early treatment has the best chance of success. But at any point, treatment can help. It will not wipe out the bad memories. But it can help you feel more in control of your emotions, have fewer symptoms, and enjoy life again.

Frequently Asked Questions

The cause of post-traumatic stress disorder (PTSD) is still being studied. Experts believe that chemicals or hormones released during a traumatic situation may cause long-term changes in the structures and functions of the brain, causing symptoms of PTSD.¹

The disorder does not occur in everyone who has had a traumatic experience. People are more likely to get PTSD if they have a history of childhood trauma, preexisting mental health conditions, or a family history of mental health conditions.¹

A physically threatening event that caused a reaction of fear, helplessness, or horror, or even just feeling that your life is in danger can trigger PTSD. Examples of traumatic events that can lead to PTSD include:²

• War combat or living in a war-torn area.
• Terrorist attacks.
• Violent crimes, such as rape, sexual abuse, domestic abuse, or physical assault.
• A serious accident, injury, or change in health, such as a car wreck or diagnosis of a life-threatening illness.
• A natural disaster such as a fire, tornado, flood, or earthquake.

Symptoms of post-traumatic stress disorder (PTSD) can be terrifying and even disabling. They can begin right after the trauma. However, PTSD cannot be diagnosed unless symptoms last at least 1 month, cause significant distress, or interfere with work or home life. Sometimes symptoms occur years later. They may include:³

• Reliving the event. You may have upsetting memories of the traumatic event. These memories can come back when you are not expecting them. They can cause both emotional and physical reactions. Sometimes these memories can feel so real it is as if the event is actually happening again. This is called a "flashback." Reliving the event may cause intense feelings of fear, helplessness, and horror similar to the feelings you had when the event took place. This distress may cause symptoms of extreme anxiety or a panic attack.
• Avoiding reminders of the event. You may try to avoid situations that trigger memories of the traumatic event. You may avoid going near the place where the trauma occurred or seeing TV programs or news reports about the event. You may avoid other sights, sounds, smells, or people that are reminders of the traumatic event. You may also forget, or be unable to talk about, important parts of the event.
• Becoming numb. PTSD may make it difficult for you to be in touch with your feelings or express emotions toward other people. For example, you may:
  • Feel emotionally "numb" and may isolate yourself from others.
  • Not be interested in activities you once enjoyed.
  • Think that you will have a shortened life span or will not reach personal goals such as having a career or family.
• Feeling emotionally tense. You may feel constantly alert after the traumatic event. This is known as increased emotional arousal, and it can cause:
  • Difficulty sleeping.
  • Outbursts of anger or irritability.
  • Difficulty concentrating.
  • Constantly fearing for your safety.
  • Becoming overly startled when someone surprises you.

Other symptoms

PTSD symptoms also may include:⁴

• Physical symptoms with no apparent cause (called somatic complaints).
• Feelings of shame, despair, or hopelessness.
• Difficulty controlling emotions.
• Relationship problems or withdrawal from relationships.
• Impulsive or self-destructive behavior.
• Changed beliefs or changed personality.

These symptoms can also occur if you have another disorder such as depression or anxiety along with PTSD.

PTSD in children

Symptoms of PTSD in children and teens are often similar to those in adults. However, children and teens can have additional or unique symptoms or problems. For example, children may repeatedly act out the traumatic event in play.

It can be difficult to recognize PTSD symptoms in toddlers and very young children because young children often have not developed the verbal skills needed to express their feelings. Symptoms of PTSD in toddlers and young children can include a delay in developing skills, such as learning to talk or toilet training. Other symptoms of PTSD in very young children include sleep disturbances, anxiety, or being easily startled and unable to relax.⁵

School-aged children with PTSD may be disorganized, have trouble concentrating, or be aggressive. They may reenact the traumatic event in play or drawings. Sleep disturbances are also common in children with PTSD. Like adults with the disorder, older children and teens are at increased risk of abusing alcohol and drugs.^{5, 6}

Other conditions related to PTSD

Symptoms that occur within 1 month of a traumatic event may be caused by another anxiety disorder known as acute stress disorder. This disorder is similar to PTSD but occurs immediately after the traumatic event. If symptoms continue for more than 1 month, the condition may then be diagnosed as PTSD. Professional counseling⁷ is also needed to treat acute stress disorder and may be helpful in preventing the development of PTSD.⁸

It is common for other conditions to occur along with PTSD, such as depression, anxiety, or substance abuse.⁷ If you had another mental health condition before the traumatic event, your symptoms of PTSD and the other condition may be more difficult to treat.

Post-traumatic stress disorder (PTSD) is diagnosed when you have experienced or witnessed a traumatic event that caused you to react with intense fear, helplessness or horror; you have had symptoms of PTSD for longer than 1 month; and your symptoms have impaired your ability to function.

While many people experience a traumatic event in their lifetime, most people who experience a traumatic event do not develop PTSD.

Most people show improvement when they are treated with professional counseling. Treatment may also include medicines such as antidepressants. Effective treatment for PTSD often takes 3 to 6 months but may last 1 to 2 years or longer. For people who seek treatment, the average length of PTSD symptoms is about 3 years. For people who do not seek treatment, the average length of PTSD symptoms is about 5 years.⁹ Some people recover completely over time, but others struggle with symptoms for the rest of their lives.

Individual differences

Post-traumatic stress disorder (PTSD) varies from person to person. Symptoms may develop soon after a traumatic event for some and months or years later for others. The severity of your symptoms is affected by how strongly you responded to the event. The types of symptoms and the things that trigger them also vary. There are several other differences that may affect PTSD:

• If you are very young or are elderly, you may have more difficulty recovering from a traumatic event.⁶
• If you develop acute stress disorder immediately following a traumatic event, you may be at increased risk for developing PTSD.
• Adults who develop PTSD from an event during childhood (such as repeated abuse) are more likely to have additional problems, including depression. They may also have more difficulty making decisions and planning for the future.
• Children with PTSD may have different symptoms than adults. A child with PTSD may reenact the event through play, have outbursts of anger, or experience sleep problems and nightmares. Childhood PTSD may last into adulthood and may be linked to other long-term mental health conditions.
• If you have had other mental health conditions in the past, they may reoccur when you get PTSD.
• Other mental health conditions that sometimes occur with PTSD, such as depression, anxiety, and substance abuse, can make diagnosing and treating the disorder more complicated.

Increased risk of suicide

PTSD can increase your risk for suicide, especially if you also have another condition such as depression, a substance abuse problem, panic attacks, or severe anxiety.⁴ Warning signs of suicide include:

• Using illegal drugs or drinking alcohol heavily.
• Talking, writing, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives.
• Spending long periods of time alone.
• Giving away possessions.
• Behaving aggressively or suddenly appearing calm.

Not everyone who experiences an intense, traumatic, or frightening event will develop post-traumatic stress disorder (PTSD). However, your risk for developing PTSD increases if you were directly exposed to the traumatic event as a victim or a witness, you were exposed to trauma that lasted for a long period of time or was ongoing; the event seemed very significant or intense to you; or you had a severe reaction to the event, such as shaking, crying uncontrollably, having a racing heartbeat, or vomiting.

You are also more likely to develop PTSD if you:⁴

• Suffered from childhood abuse or other traumatic experiences.
• Have other mental health disorders or a family history of mental health problems.
• Have limited support from family or friends.
• Are female.
• Have had recent, stressful life changes.
• Drink excessive amounts of alcohol.
• Have had a recent loss, especially if it was unexpected.

Call 911 or other emergency services immediately if:

• You think you cannot keep from harming yourself or someone else.
• You hear voices.
• Someone you know attempts suicide or shows warning signs of suicide, such as talking about suicide or about harming someone else. Other warning signs include being out of touch with reality (psychosis) or using alcohol or drugs excessively.

Call your health professional if you have any of the following symptoms for more than 1 month:³

• You have difficulty sleeping, controlling anger, or concentrating; are overly fearful for your safety; or have feelings of intense guilt because you survived a traumatic event while others did not.
• You have attacks of intense fear or anxiety that seem to come on without a reason, or you feel continuously anxious.
• You have occasional physical symptoms such as chest pain, a rapid or irregular heartbeat (palpitations), or trouble breathing.
• You have symptoms such as intrusive thoughts, upsetting reminders, or nightmares about the trauma.

Watchful Waiting

Watchful waiting means taking a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.

Watchful waiting may be appropriate if you have feelings of grief, sadness, or melancholy as a result of a traumatic event. Sometimes these feelings go away on their own. However, people who have experienced or witnessed a traumatic event often need help from health professionals who are specially trained. If your symptoms do not improve after 3 months and they are either causing you distress or are getting in the way of your work or home life, talk with a health professional. If your symptoms are severe and disruptive, seek treatment right away.

Who To See

Diagnosis and medicine management for post-traumatic stress disorder can be provided by a:

• Psychiatrist.
• Psychologist.
• Internist.
• Family medicine physician.
• General practitioner.
• Physician assistant.
• Nurse practitioner.

Professional counseling can be provided by a:

• Psychiatrist.
• Psychologist.
• Social worker who has training in post-traumatic stress disorder.
• Licensed mental health counselor who has training in post-traumatic stress disorder.
• Psychiatric nurse.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

If you think you have post-traumatic stress disorder (PTSD), your health professional may ask detailed questions to determine the cause and severity of your symptoms. You may be asked to answer verbal questions or to respond to written questions. You may be asked about:⁴

• The traumatic event that is causing the symptoms.
• Any other traumatic events in your past, including events that occurred when you were a child.
• Military service, especially if you have ever been in combat.
• Any legal issues related to the traumatic event that is causing your symptoms.
• Any other mental health conditions that you may have.
• Mental health conditions in your family.
• Whether you have any suicidal thoughts or thoughts of harming others.

Your health professional may give you a complete mental health assessment, which includes an evaluation of your emotions and your ability to think, reason, and remember. With your permission, close family members may also be asked about your symptoms or behaviors. The assessment may also involve a physical exam, written or verbal tests, and lab tests such as blood and urine tests.

Your health professional may give you tests to make sure that your symptoms are not caused by other conditions that have symptoms similar to PTSD. Other conditions with similar symptoms include:

• Other mental health problems, such as depression, personality disorders, or anxiety disorders.
• A head injury or conditions that affect your brain, such as seizures, brain tumors, or infections of the brain.
• Substance abuse problems, such as alcohol or drug addiction.
• Thyroid gland problems. An overactive thyroid gland (hyperthyroidism) can cause symptoms such as nervousness and a rapid, pounding heartbeat that can be confused with PTSD.
• Long-term lack of sleep, although symptoms usually are not as severe as the symptoms of PTSD.
• Attention deficit hyperactivity disorder (ADHD), a behavioral condition in which people have difficulty paying attention, may be more active than normal, and tend to act without thinking.

Treatment for post-traumatic stress disorder (PTSD) usually includes professional counseling, such as cognitive-behavioral therapy, and sometimes medicines, such as antidepressants. Treatment may also include education and other support.

Treatment can reduce your symptoms, help you function normally, make you feel safe, and help prevent symptoms from returning. Treatment is also needed for any other disorders that occur along with PTSD, such as depression or substance abuse.

It can be very upsetting to talk about traumatic events. It is very important to establish comfortable, trusting relationships with your health professionals.

It is also important that you acknowledge the effect that a traumatic event has had on you and seek help. Untreated PTSD can lead to long-lasting physical and emotional distress. If you try to relieve symptoms by isolating yourself, trying to forget the traumatic event on your own, or using alcohol or drugs to quiet the memories, you may have additional problems, such as depression, substance abuse problems, or panic attacks.

Seeking help can prevent a worsening of symptoms, more emotional and physical distress, anxiety, and problems maintaining relationships.

Initial treatment

Most people who are diagnosed with post-traumatic stress disorder (PTSD) are treated as outpatients. Those who have other severe medical or mental health conditions or who may try to harm themselves or others may need a period of treatment in a hospital.

Professional counseling. In general, treatment involves professional counseling for 3 to 6 months. Counseling can reduce symptoms by helping you deal with the traumatic event, reconnect with other people, and resume a normal lifestyle.

Cognitive-behavioral therapy effectively treats symptoms of PTSD. The most common types of cognitive-behavioral therapy used to treat PTSD include:¹⁰

• Cognitive therapy, which focuses on changing certain thinking and behavior patterns.
• Exposure therapy, which helps you work through fears by confronting a feared object or situation in a controlled environment.
• Eye movement desensitization and reprocessing (EMDR), which includes elements of cognitive therapy and exposure therapy as well as eye movement exercises. Although this type of treatment appears to be helpful, exactly how it works is not well understood.⁴

Other types of therapy include:

• Brief psychodynamic psychotherapy, which focuses on helping you become aware of unconscious thoughts and feelings. This can help you understand why you are reacting in a particular way.
• Family therapy, which can help all family members deal with and understand the effects of PTSD.
• Self-help or support group therapy. This therapy may be helpful, but its effectiveness is still being studied.⁴

Medicines. You may need to take medicines, in addition to using counseling, to help reduce PTSD symptoms.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and paroxetine (Paxil) are commonly used to treat symptoms of PTSD and related conditions such as depression and anxiety.

Other antidepressant medicines that may be used to treat symptoms of PTSD include:

• Tricyclic antidepressants, such as imipramine (Tofranil, for example) or amitriptyline (Elavil, for example). These antidepressant medicines may be effective in treating PTSD, but they have more side effects than SSRIs.
• Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) or tranylcypromine (Parnate). Because these antidepressant medicines can have severe side effects, they are usually not the first medicine tried.
• Atypical antidepressants such as mirtazapine (Remeron) and venlafaxine (Effexor). These medicines may be useful in treating PTSD, but further study is needed to determine their effectiveness.¹¹

Other types of medicines that may be effective in treating symptoms of PTSD include:

• Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium (such as Lithobid, Lithane, Eskalith), and sodium valproate.¹² Mood stabilizers can be combined with other medicines (such as antidepressants) that are used to treat PTSD. Carbamazepine and lamotrigine may increase the chance of birth defects. If you are pregnant or thinking about becoming pregnant, talk to your doctor before taking this medicine.
• Atypical antipsychotic medicines such as olanzapine (Zyprexa) and risperidone (Risperdal). These medicines are currently being studied for their effectiveness in treating certain symptoms of PTSD. Although research is still limited, initial studies indicate that these medicines may be effective in treating symptoms that have not been relieved by other medicines, such as nightmares and flashbacks.¹³

Ongoing treatment

For some people, treatment for post-traumatic stress disorder (PTSD) can last 3 to 6 months. Others may require ongoing treatment for continued symptoms of PTSD, including professional counseling, medicines, and stress management. In these cases, treatment for PTSD may last for 1 to 2 years or longer.

Cognitive-behavioral therapy can effectively treat symptoms of PTSD. This type of therapy includes:¹⁰

• Cognitive therapy, which focuses on changing certain thinking and behavior patterns.
• Exposure therapy, which helps you work through fears by confronting a feared object or situation in a controlled environment.
• Eye movement desensitization and reprocessing (EMDR), which includes elements of cognitive therapy and exposure therapy as well as eye movement exercises. Although this type of treatment appears to be helpful, exactly how it works is not well understood.⁴

Other types of therapy include:

• Brief psychodynamic psychotherapy, which focuses on helping you become aware of unconscious thoughts and feelings. This can help you understand why you are reacting in a particular way.
• Family therapy, which can help all family members deal with and understand the effects of PTSD.
• Self-help or support group therapy. This therapy may be helpful, but its effectiveness is still being studied.⁴

Medicines. You may need to add medicines to counseling to help reduce PTSD symptoms. If medicines that you are taking are not effective or have side effects that are intolerable, you may need a change in dose, additional medicines, or different medicines altogether.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and paroxetine (Paxil, for example) are commonly used to treat symptoms of PTSD and related conditions such as depression and anxiety.

Other antidepressant medicines that may be used to treat symptoms of PTSD include:

• Tricyclic antidepressants, such as imipramine (Tofranil, for example) or amitriptyline (Elavil, for example). These antidepressant medicines may be effective in treating PTSD, but they have more side effects than SSRIs.
• Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), isocarboxazid (Marplan), or tranylcypromine (Parnate). Because these antidepressant medicines can have severe side effects, they are usually not the first medicine tried.

Other types of medicines that may be effective in treating symptoms of PTSD include:

• Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium (such as Lithobid, Lithane, Eskalith), and sodium valproate.¹² Mood stabilizers can be combined with other medicines (such as antidepressants) that are used to treat PTSD. Carbamazepine and lamotrigine may increase the chance of birth defects. If you are pregnant or thinking about becoming pregnant, talk to your doctor before taking this medicine.
• Atypical antidepressants such as mirtazapine (Remeron) and venlafaxine (Effexor). These medicines may be useful in treating PTSD, but further study is needed to determine their effectiveness.¹¹
• Atypical antipsychotic medicines such as olanzapine (Zyprexa) and risperidone (Risperdal). These medicines are currently being studied for their effectiveness in treating certain symptoms of PTSD. Although research is still limited, initial studies indicate that these medicines may be effective in treating symptoms that have not been relieved by other medicines, such as nightmares and flashbacks.¹³

Lifestyle choices. Living a healthy lifestyle can help you manage symptoms of PTSD. Lifestyle choices that can help reduce stress and symptoms of PTSD include:

• Getting regular exercise, an important part of maintaining your physical and emotional health.
• Getting adequate sleep by maintaining healthy sleep habits.
• Eating a balanced diet that is low in saturated fat and includes plenty of fresh fruits and vegetables.

Stress management. Reducing stress in your daily life can help you manage symptoms of PTSD. Ways to help reduce stress might include:

• Doing relaxation exercises, such as breathing exercises or muscle relaxation exercises.
• Reducing anxiety by developing healthy habits and choosing relaxing activities.
• Meditating, which usually involves slow, regular breathing and sitting quietly for at least 15 to 20 minutes.
• Praying, which may help people find an inner sense of meaning or strength during difficult times.

For more information about relieving stress, see the topic Stress Management.

Treatment if the condition gets worse

If your condition gets worse while you are being treated with professional counseling and medicines for post-traumatic stress disorder (PTSD), you may stay in a hospital or another treatment facility to help manage your symptoms so that you are able to return to normal functioning.

If you have additional mental health issues, all conditions need to be treated appropriately or treatment for PTSD will take longer and be less successful.

There is some evidence that certain forms of counseling, such as cognitive-behavioral therapy, help prevent or lessen symptoms of post-traumatic stress disorder after a traumatic event.¹⁴

You can take many steps at home to help you cope with post-traumatic stress disorder (PTSD), such as:

• Getting regular exercise. Try moderate activity for at least 30 minutes a day, most days of the week, if possible. Moderate activity is activity equal to a brisk walk. For more information, see the topic Fitness.
• Getting adequate sleep. Keep your room dark and quiet, and try to go to bed at the same time every night.
• Eating a balanced diet. A balanced diet has foods from different food groups , including whole grains, dairy, fruits and vegetables, and protein. For more information, see the topic Healthy Eating.
• Avoiding alcohol and drugs.
• Reducing anxiety by developing healthy habits and choosing relaxing activities.
• Doing relaxation exercises, such as breathing exercises and muscle relaxation exercises.
• Meditating, which usually involves slow, regular breathing and sitting quietly for at least 15 to 20 minutes.
• Praying, which may help people find an inner sense of meaning or strength during difficult times.

You may have problems handling frustration and anger related to PTSD. There are ways to overcome frustration and anger; ask your professional counselor for additional help on handling these emotions.

When a family member has PTSD, the entire family is affected. If someone in your family has PTSD, you may feel frustrated when your attempts to help do not work. You may also feel isolated because your loved one does not join in activities that you used to enjoy together.

Family therapy can provide needed information about PTSD and help family members cope. If you do not understand PTSD or are having problems dealing with a family member with PTSD, talk with a health professional.

Medicines, along with professional counseling, may reduce symptoms such as depression and anxiety associated with post-traumatic stress disorder (PTSD).

Medication Choices

You may need to take medicines to help reduce PTSD symptoms.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and paroxetine (Paxil, for example) are commonly used to treat symptoms of PTSD and related conditions such as depression and anxiety.

Other antidepressant medicines that may be used to treat symptoms of PTSD include:

• Tricyclic antidepressants, such as imipramine (Tofranil, for example) or amitriptyline (Elavil, for example). These antidepressant medicines may be effective in treating PTSD, but they have more side effects than SSRIs.
• Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), isocarboxazid (Marplan), or tranylcypromine (Parnate). Because these antidepressant medicines can have severe side effects, they are usually not the first medicine tried.

Other types of medicines that may be effective in treating symptoms of PTSD include:

• Mood stabilizers, such as carbamazepine (Tegretol, for example), lamotrigine (Lamictal), lithium (such as Lithobid, Lithane, Eskalith), and sodium valproate.¹² Mood stabilizers can be combined with other medicines (such as antidepressants) that are used to treat PTSD. Carbamazepine and lamotrigine may increase the chance of birth defects. If you are pregnant or thinking about becoming pregnant, talk to your doctor before taking this medicine.
• Atypical antidepressants such as mirtazapine (Remeron) and venlafaxine (Effexor). These medicines may be useful in treating PTSD, but further study is needed to determine their effectiveness.¹¹
• Atypical antipsychotic medicines such as olanzapine (Zyprexa) and risperidone (Risperdal). These medicines are currently being studied for their effectiveness in treating certain symptoms of PTSD. Although research is still limited, initial studies indicate that these medicines may be effective in treating symptoms that have not been relieved by other medicines, such as nightmares and flashbacks.¹³

What To Think About

It may take several weeks before these medicines become effective. For treating PTSD, medicines work best when combined with professional counseling (such as cognitive-behavioral therapy).

FDA Advisories. The US Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines, but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

There is no surgical treatment for post-traumatic stress disorder.

Professional counseling is the most important part of treatment for post-traumatic stress disorder (PTSD). Other therapies, such as relaxation exercises and possibly medicines, may be added to counseling to help reduce stress in your life and manage symptoms of PTSD.

Other Treatment Choices

The most common types of cognitive-behavioral therapy used to treat symptoms of PTSD include:¹⁰

• Cognitive therapy, which focuses on changing certain thinking and behavior patterns.
• Exposure therapy which helps you work through fears by confronting a feared object or situation in a controlled environment.
• Eye movement desensitization and reprocessing (EMDR), which includes elements of cognitive therapy and exposure therapy as well as eye movement exercises.

Other types of therapy sometimes used to treat post-traumatic stress disorder include:

• Brief psychodynamic psychotherapy, which focuses on helping you become aware of unconscious thoughts and feelings. This can help you understand why you are reacting in a particular way.
• Family therapy, which can help all family members deal with and understand the effects of PTSD.
• Self-help or support group therapy. This therapy may be helpful, but its effectiveness is still being studied.⁴

What To Think About

Studies indicate that cognitive-behavioral therapy may be more beneficial than other types of therapy for the treatment of PTSD.¹⁴

Organizations

• Alcohol Abuse and Dependence
• Alcohol and Drug Problems
• Anxiety
• Depression
• High Blood Pressure (Hypertension)
• Panic Attacks and Panic Disorder

Citations

1. Anxiety disorders (2003). In RE Hales, ST Yudofsky, eds., Textbook of Clinical Psychiatry, 4th ed., pp. 595–630. Washington, DC: American Psychiatric Publishing.

2. Yehuda R (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2): 108–114.

3. American Psychiatric Association (2000). Posttraumatic stress disorder. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 463–472. Washington, DC: American Psychiatric Association.

4. American Psychiatric Association (2004). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. American Journal of Psychiatry, 161(11, Suppl): 3–31.

5. Lonigan CJ, et al. (2003). Posttraumatic stress disorder in children: Diagnosis, assessment, and associated features. Child and Adolescent Psychiatric Clinics of North America, 12(2): 171–194.

6. Sadock BJ, Sadock VA (2003). Posttraumatic stress disorder and acute stress disorder. In Kaplan and Sadock's Synopsis of Psychiatry, 9th ed., pp. 623–632. Philadelphia: Lippincott Williams and Wilkins.

7. Davidson RT (2001). Recognition and treatment of posttraumatic stress disorder. JAMA, 286(5): 584–588.

8. Bryant RA, et al. (1999). Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journal of Psychiatry, 156(11): 1780–1786.

9. Gillette GM, Fielstein EM (2000). Posttraumatic stress disorder and acute stress disorder. In MH Ebert et al., eds., Current Diagnosis and Treatment in Psychiatry, pp. 341–350. New York: McGraw-Hill.

10. Rothbaum BO, et al. (2000). Cognitive-behavioral therapy. In EB Foa et al., eds., Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies, pp. 60–83. New York: Guilford Press.

11. Stein DJ, et al. (2004). Pharmacotherapy for post-traumatic stress disorder. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

12. Stein DJ, et al. (2003). WCA recommendations for the long-term treatment of posttraumatic stress disorder. CNS Spectrums, 8(Suppl 1): 31–39.

13. Grinage BD (2003). Diagnosis and management of post-traumatic stress disorder. American Family Physician, 68(12): 2401–2408.

14. Bisson J (2004). Post-traumatic stress disorder. Clinical Evidence (11): 1343–1360.

Other Works Consulted

• Gillette GM, Fielstein EM (2000). Posttraumatic stress disorder and acute stress disorder. In MH Ebert et al., eds., Current Diagnosis and Treatment in Psychiatry, pp. 341–350. New York: McGraw-Hill.

• Kessler RC, et al. (1995). Posttraumatic stress disorders in the National Comorbidity Survey. Archives of General Psychiatry, 52(12): 1048–1060.

• Servan-Schreiber D (2002). Eye movement desensitization and reprocessing psychotherapy: A model for integrative medicine. Alternative Therapies, 8(4): 100–103.

Author:	Stuart J. Bryson Christine Wendt, R.D., L.D.	Last Updated June 13, 2005
Medical Review:	Patrice Burgess, MD - Family Medicine Adam Husney, MD - Family Medicine Malin K. Clark, MD, FRCPC - Psychiatry Jessica Hamblen, PhD - Post Traumatic Stress Disorder
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