PTSD Treatment, Therapy, Prognosis And Medication
Untreated chronic PTSD may diminish in severity without totally resolving, but some individuals will remain severely disabled without treatment. Complete recovery occurs within three months in about half of all cases, with many others having symptoms for a year or longer after the trauma. Early treatment of a trauma may help prevent the onset of PTSD; not surprisingly, prompt diagnosis and strong social support both increase the chance of symptom resolution. PTSD also carries with it the risk of other mental health problems such as depression, panic attacks, and alcohol or drug abuse. It is important that an individual’s treatment plan address these possible other problems as well.
A variety of strategies can be used to successfully treat PTSD, including various forms of psychotherapy (talk therapy) and drug therapy. A doctor or therapist may choose to combine various forms of therapy according to an individual’s needs.
The goal of psychotherapy is to teach individuals better ways to respond to their symptoms. Cognitive behavioral therapy, or CBT, is one of the most effective and common forms of psychotherapy used for the treatment of PTSD. During this type of treatment, a therapist may try to desensitize patients by exposing them to an element of the trauma previously experienced, this time in a safe way, helping patients learn to control their fears. CBT also aims to help individuals think about their difficult memories in a more realistic way. In general, the therapist aims to reduce PTSD symptoms by teaching people how to reduce their own anxiety. Both group and individual based CBT have been found to be effective. Psychotherapy for PTSD usually lasts six to twelve weeks, though it may continue longer for some patients.
A number of scientific studies have found another related therapy to be highly effective for the treatment of PTSD: Eye Movement Desensitization and Reprocessing (EMDR). EMDR incorporates methods from cognitive behavioral therapy as well as a bilateral stimulation component, during which individuals move their eyes back and forth as they recall both positive and negative memories. Other treatments for PTSD include hypnotherapy, acupuncture, and meditation. These techniques may help some individuals, but scientific evidence of their efficacy is not well established.
A good deal of research does support the use of pharmacological therapy for PTSD; a class of drugs called selective serotonin reuptake inhibitors, or SSRIs, have been found to be particularly effective. The only drugs approved by the FDA for the treatment of PTSD belong to this class: sertraline (Zoloft TM) and paroxetine (Paxil TM). These medications may help control feelings of sadness, anger, guilt, and worry, and they may make it easier for an individual to go through talk therapy.
Like all medications, sertraline and paroxetine come with potential side effects. Often these side effects go away after a few days, but sometimes they persist. The most common side effects of SSRIs like sertraline and paroxetine include headache, nausea, constipation, agitation, fatigue, sleeplessness, and reduced sex drive. Indeed, side effects can potentially manifest in almost any organ system, though most are not serious and uncommon.
Your health care provider may prescribe other drugs in the SSRI family such as citalopram (Celexa TM) or fluoxetine (Prozac TM). Many other types of drugs can also be helpful. These include other classes of antidepressants, mood stabilizing drugs such as valproic acid (Depakote TM), anti-anxiety medications such as benzodiazepenes, and medications for sleep. All of these drugs can come with side effects as well. You should discuss side effects from any medication with your health care provider.
Anxiety Disorders. In: Beers, MB, ed. The Merck Manual. Eighteenth Edition. Whitehouse Station, NJ: Merck Research Laboratories; 2006: 1672-1678.
To Learn More
To learn more, we recommend the following sites:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). psychiatryonline.com
National Center for PTSD. United States Department of Veterans Affairs.
National Institute of Mental Health. PTSD.
Pubmed Health. A.D.A.M. Medical Encyclopedia. Post Traumatic Stress Disorder
Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002795.
Stergiopoulos E, Cimo A, Cheng C, Bonato S, Dewa CS. Interventions to improve work outcomes in work-related PTSD: a systematic review. BMC Public Health. 2011 Oct 31;11(1):838. [Epub ahead of print]