The symptoms of post-traumatic stress disorder (PTSD) can be severe and manifest in different ways. Intrusive symptoms like flashbacks and nightmares can lead to heightened reactivity as well as to blunted emotions and dissociative symptoms. People with PTSD sometimes become more impulsive or aggressive but can also become withdrawn and avoidant. They can alternate between these different responses in unpredictable intervals.

To be effective, treatment for PTSD typically addresses this full range of symptoms. This means it must be multi-faceted, systematic, flexible and responsive. While PTSD treatment focuses on one or more types of therapy, it may also include medication and additional support services and interventions. PTSD treatment options and protocols are the focus of extensive research and are actively being improved as clinicians continue to study the effects of trauma.

Medications for PTSD

Medication for PTSD typically targets the brain’s threat-processing systems, aiming to reduce intrusive symptoms and any depressive and anxiety symptoms that accompany them. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat both depression and anxiety and also can be effective medications for PTSD. These medications can lower anxious rumination, improve emotional range, reduce intrusive symptoms and help people feel less irritable and on edge.

Fluoxetine (Prozac)

Prozac can effectively alleviate symptoms of depression within a week and is a safe and effective medication for a wide range of people. Prozac for PTSD is a good choice for people with serious cognitive symptoms who want to improve their mental clarity and emotional responsiveness. It is a particularly good choice for people with comorbid PTSD and major depressive disorder.

Prozac has been shown to rejuvenate the brain by increasing its plasticity and to help with anxiety as well as depression. However, it is not the best choice for every person with PTSD. Research shows that it may be less effective than other medications in treating the intrusive symptoms of PTSD. Also, like other SSRIs, Prozac can trigger changes in sleep and may not be the best option for people with significant insomnia or other sleep problems.

Paroxetine (Paxil)

Like Prozac, Paxil is an SSRI that is used to treat both depression and anxiety. It was one of the first SSRIs approved for the treatment of panic disorder and is used to treat a wide range of anxiety disorders, including social anxiety disorder and obsessive-compulsive disorder.

Paxil for PTSD is a good choice for people with significant avoidance symptoms and especially for those with comorbid anxiety disorders. Paxil can help people become more outgoing and socially engaged. Studies have shown that it can effectively address the full range of PTSD symptoms, including intrusive symptoms. Like Prozac, it can cause sleep disruptions and have other side effects that may determine whether it is a good choice for a particular case of PTSD.

Sertraline (Zoloft)

Zoloft is an SSRI that is commonly used to treat depressive and anxiety disorders. It was the first drug approved by the Food and Drug Administration (FDA) for the treatment of PTSD. Zoloft for PTSD is an effective choice for people looking for a single medication that can treat the full range of PTSD symptoms, including intrusive symptoms.

The medication is especially effective for treating numbing and hyperarousal symptoms. Like other SSRIs, it can cause sleep problems and other side effects that may make it a less favorable option for some people with PTSD.

Venlafaxine (Effexor)

Effexor is an SNRI antidepressant that is also used to treat a range of anxiety conditions. Its side effects vary but are slightly different from those of simple SSRIs. For this reason, it can be good for people with sensitivities to SSRIs.

Effexor for PTSD effectively addresses avoidance, numbing and re-experiencing symptoms. Research shows that it is also a good choice for people with comorbid PTSD and depression. It is strongly recommended for the treatment of PTSD by the U.S. Department of Defense and Department of Veterans Affairs (VA).

Therapies for PTSD

While medications can reduce distressing symptoms and make them more manageable, they do not address the psychological wounds of trauma. Therapy can facilitate deeper healing and help people regain optimism and a sense of control. It can also help them learn additional tools for symptom management, like relaxation and anger control skills.

Therapy can provide a safe place for people who have experienced trauma to explore and confront what happened, allowing traumatized individuals to process feelings that can be overwhelming to handle alone. This helps people with PTSD regain a sense of safety, feel empowered and overcome the sense of helplessness traumatic events often induce.

Cognitive Processing Therapy

Cognitive processing therapy (CPT) is one of the most effective trauma-focused therapies for the treatment of PTSD. It is recommended by the VA for combat veterans with PTSD and is also a good choice for civilians who experience the disorder.

Cognitive processing therapy for PTSD helps people understand how trauma changed the ways they think and feel and learn new ways to think about what happened. It specifically focuses on reducing negative thinking and self-blame. CPT is a structured treatment protocol that lasts for 12 weeks and includes weekly 60- to 90-minute sessions, writing exercises and homework.

Prolonged Exposure Therapy

Prolonged exposure therapy (PET) is another trauma-focused psychotherapy recommended by the VA for people with PTSD.  Prolonged exposure therapy for PTSD involves gradual exposure to memories, thoughts and emotions related to the trauma.

Behavioral interventions, including relaxation techniques, are used to help patients as they practice imaginal exposure, which involves placing themselves mentally in the places and situations they have avoided since the trauma. Clients also practice in vivo exposure, or gradual exposure to the real-life scenarios they previously avoided. PET usually takes eight to 15 weeks of 60- to 90-minute weekly sessions to complete.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is also a VA-approved trauma-focused therapy. This unique form of gradual exposure therapy provides tools for coping with traumatic stimuli.

In EMDR sessions, people focus on memories, feelings, thoughts and bodily sensations related to the trauma they experienced while paying attention to alternating visual or auditory signals. This helps the brain reprocess the trauma and become less reactive to it. EMDR has been shown to be effective for PTSD and other trauma-related conditions and usually requires one to three months of 50- to 90-minute sessions.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is one of the most thoroughly studied psychotherapies and is an effective and evidence-based intervention for a wide range of mental health conditions. In CBT, people examine their thoughts and identify irrational or distorted beliefs that exacerbate negative emotions and behavior. By challenging and reframing their thinking, people can empower themselves to engage with life in more positive ways.

Treatment for PTSD and Co-Occurring Conditions

All co-occurring psychiatric disorders respond best to an integrated treatment approach in which interventions are provided by a group of professionals who communicate regularly and coordinate services, often through the same organization or program.

Types of interventions provided by an integrated treatment team can include groups, individual therapy and medication management. All clinicians on the team should utilize evidence-based interventions, ideally ones that are appropriate for treating a range of conditions.

In many cases, interventions that target PTSD can also be used to treat comorbid conditions. For example, both PTSD and depression respond to CBT and SSRIs. It is rare that a person needs to see different individual therapists for PTSD and depression, though they might benefit from attending separate groups for each.

PTSD and Addiction

Many aspects of addiction treatment still work well for people with both mental health and substance use disorders, such as treatment groups that foster mutual learning and support.

However, while people with only substance use disorders might not need additional services beyond standard weekly groups, dual-diagnosis clients nearly always do. It can be an effective approach for the same organization to provide individual therapy, medication management and treatment groups.

Specific interventions for PTSD can also be used to treat substance use disorders. Therapies including CBT, CPT and PET all have been proven to work for people with co-occurring PTSD and substance use disorders. In addition, special interventions have also been designed for these dually-diagnosed disorders:

  • Seeking Safety is a systematic, manual-based intervention for people with comorbid trauma-related and substance use disorders that helps clients set boundaries, decrease high-risk behavior, manage emotions and prevent relapse.
  • Transcend is a program that incorporates elements from CBT, psychodynamic therapy and 12-step treatment programs to help clients cope with PTSD symptoms while maintaining abstinence from substance use.

Some dually diagnosed clients may be able to recover using one of these programs alone, though most will also require individual therapy and medication management.

Several treatment options for people with PTSD and substance use disorders are available at The Recovery Village. Contact a representative at The Recovery Village today to learn about programs that can help you or a loved one start to heal from trauma and addiction.