Posttraumatic Stress Disorder (PTSD)

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Questions to Ask Your Doctor about PTSD
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Treatment

A combination of psychotherapy and medication is commonly used to treat PTSD. Despite the fact that many methods of psychotherapy and types of medication have been used to treat PTSD, little evidence about their effectiveness has been produced.

Psychotherapy
Psychotherapeutic treatments include the following:

• Debriefing (i.e., crisis intervention)
• Psychotherapy
• Community agencies
• Eye movement desensitization and reprocessing (EMDR)

Debriefing sessions are usually conducted as soon after the event as possible. The session usually lasts about 2 hours. A debriefing session typically involves a discussion of the event, the person's reaction to it, and coping strategies. Debriefing sessions are commonly used to help rescue personnel, classmates of students who die in auto accidents or as a result of a violent attack (e.g., victims of random shootings), and survivors of terrorist attacks (e.g., bombings of public buildings).

Psychotherapy is generally necessary in the treatment of PTSD, whether it is conducted in individual therapy or in "survivor group" therapy. Survivor groups may be associated with or may refer group members to local community agencies that offer therapy and support for victims of rape, domestic violence, combat, natural disasters, and so on.

The goal of psychotherapy in the treatment of PTSD is to help the person address and manage painful memories until they no longer cause disabling symptoms. This begins after establishing a safe relationship between the client and therapist. The process involves gradually working through the traumatic event and the patient's reactions to it, validating the patient's experiences, repairing damage done to their identity, and dealing with loss.

Eye movement desensitization and reprocessing (EMDR) is a specialized form of psychotherapy that is used primarily for treating PTSD and its associated conditions, including depression. EMDR typically is integrated into a conventional psychotherapy regimen and is not used alone to treat PTSD.

The theory behind EMDR is that stimulated rapid eye movement may help in the psychological processing of trauma. It is thought that the day's events and our reactions to them are processed during REM sleep. In a controlled EMDR session, a stimulus such as moving light is used to induce rapid eye movement.

The EMDR Institute reports that there are more controlled studies of EMDR and its effects than of any other trauma treatment. The EMDR Institute states that an estimated 1,000,000 people had been treated by 1995, with varying degrees of improvement. Some, but not all, studies document improvement after relatively few interventions.

Pharmacotherapy
Almost all types of psychopharmacological agents have been used to help resolve the symptoms of PTSD, but little evidence has been documented to show their effectiveness.

The use of medication in addition to psychotherapy has been shown to be beneficial in the treatment of PTSD. Treatment is symptom related.

Antidepressants
Several types of antidepressants are used to treat PTSD:

• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Selective norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)

MAOIs
MAOIs (e.g., phenelzine [Nardil®]) have been shown to reduce depression, nightmares and night terrors, flashbacks, violent outbursts, and startle reactions.

Side effects that may occur with MOAIs include dizziness, drowsiness, and blurred vision.

SSRIs
High-dose SSRI therapy (e.g., fluoxetine [Prozac®]) may reduce depression, intrusive and avoidant symptoms, anger, explosive outbursts, hyperarousal symptoms, and numbing. In 1999, the FDA approved the use of sertraline (Zoloft®) for treatment of PTSD.

Side effects that may occur with SSRIs include tardive dyskinesia, headache, gastrointestinal discomfort, weakness, loss of libido, and sexual dysfunction.

SNRIs
High-dose nefazodone (Serzone®) therapy may help control intrusive and hyperarousal symptoms.

Side effects that may occur with SNRIs include dry mouth, drowsiness, nausea, and dizziness.

TCAs
Tricyclic antidepressants (e.g., clomipramine [Anafranil®]; doxepin [Sinequan®]) have been shown to reduce insomnia and dream disturbance, anxiety, guilt, flashbacks, and depression.

Side effects that may occur with TCAs include dry mouth, blurred vision, and rapid heart beat (tachycardia).

Antipsychotics
Antipsychotics are used to treat intrusive and hyperarousal symptoms. These drugs have not been proven to relieve symptoms over the long term and have serious side effects.

Side effects that may occur with long-term use of antipsychotic medication include muscle tremors, rigidity, and spasms; and abnormal facial movements, such as lip smacking and tongue wagging.

Anxiolytics (antianxiety agents)
Anxiolytics (e.g., buspirone [BuSpar®]) have been shown to reduce anxiety, irritability, insomnia, and hypervigilance. No studies have been done demonstrate long-term effectiveness.

Benzodiazepines (e.g., diazepam [Valium®]; chlordiazepoxide [Librium®]) have a sedative effect and are used to reduce symptoms of acute stress and anxiety, such as panic attacks and phobias.

However, benzodiazepines carry a risk for substance dependence and usually are not recommended as treatment for PTSD, because patients with this disorder are often predisposed to developing substance abuse.

Mood stabilizers
Lithium has been shown to reduce intrusive symptoms and irritability.

Side effects that may occur with lithium include dry mouth, blurred vision, and rapid heart beat (tachycardia).

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