Post-traumatic stress disorder - Treating post-traumatic stress disorder (PTSD)

The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help.

Assessment

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.

Your GP will often carry out an initial assessment, but you will be referred to a mental health specialist for further assessment and treatment if you have had symptoms of PTSD for more than four weeks or your symptoms are severe.

There are a number of mental health specialists you may see if you have PTSD, such as:

a psychologist - an expert in how the mind works
a community psychiatric nurse - a nurse who specialises in mental healthcare
a psychiatrist - a mental health specialist who diagnoses and treats mental health conditions

Watchful waiting

If you have mild symptoms of PTSD, or you have had symptoms for less than four weeks, an approach called watchful waiting may be recommended.

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. It is sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience will get better without treatment within a few weeks.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychotherapy

If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination of psychotherapy and medication may be recommended If you have severe or persistent PTSD.

Psychotherapy is a type of therapy often used to treat emotional problems and mental health conditions such as PTSD, depression, anxiety and obsessive compulsive disorder.

The treatment is carried out by trained mental health professionals who will listen to you and help you come up with effective strategies to resolve your problems.

The two main types of psychotherapy used to treat people with PTSD are described below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event.

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist will help you cope with any distress you feel, while identifying any unhelpful thoughts or misrepresentations you have about the experience.

By doing this, your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience, such as feeling that you are to blame for what happened or fear that it may happen again.

You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.

You will usually have 8-12 weekly sessions of trauma-focused CBT, although fewer may be needed if the treatment starts within one month of the traumatic event. Sessions where the trauma is discussed will last for around 90 minutes.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that has been found to reduce the symptoms of PTSD.

EMDR involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident.

It is not clear exactly how EMDR works, but it may help the malfunctioning part of the brain (the hippocampus) to process distressing memories and flashbacks so that their influence over your mind is reduced.

Medication

Antidepressants such as paroxetine, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.

Of these medications, paroxetine is the only one licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and are often recommended as well.

However, these medications will only be used if:

you choose not to have trauma-focused psychological treatment
psychological treatment would not be effective because there is an ongoing threat of further trauma (such as domestic violence)
you have gained little or no benefit from a course of trauma-focused psychological treatment
you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment

Amitriptyline or phenelzine will only be used under the supervision of a mental health specialist.

Antidepressants can also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However, they are not usually prescribed for people younger than 18 unless recommended by a specialist.

If medication for PTSD is effective, it will usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medication is ineffective at reducing your symptoms, your dosage may be increased.

Before prescribing a medication, your doctor should inform you about possible side effects that you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.

For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea. Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.

See depression medicines information for more information about the medications used to treat PTSD.

Children and young people

For children and young people with PTSD, trauma-focused CBT is usually recommended.

This will normally involve a course of 8-12 sessions that have been adapted to suit the child’s age, circumstances and level of development. Where appropriate, treatment will include consulting with and involving the child's family.

Treatment with medication is not usually recommended for children and young people with PTSD.