PTSD (Post Traumatic Stress Disorder)

The Large Number of People with PTSD is Almost Overwhelming

PTSD is common so we need good PTSD treatment.  It’s so common that it’s really upsetting and heartbreaking.  As many as 5% of men and 10% of women in the US will have PTSD at some point during their life.  Just as upsetting, PTSD has always been common.  In past decades and past centuries we were unable to record how many people had it because it didn’t have a name that everyone used.  And, it’s unlikely that life has gotten better for people.  We can assume that life was harder in the past than it is now, with more PTSD.

Why Didn’t People Back Then Know About PTSD Treatment and Talk About PTSD?

PTSD, if it was named, had different names at different times and in different places.  It wasn’t a topic that came up in everyday life or even in medical settings.  Even when a country or war or clinic gave it a medical name for a while, the name would change.  Supposedly all of the PTSD back then came from military service and even then people would hide and never speak of it.  Any PTSD other than military, and there had to have been a lot of it, was “unknown” to people, out of public awareness.  Shell shock, combat stress reaction, war neurosis, soldier’s heart.  Terminology came and went with the wars and the times.  Civilian PTSD was hidden because the acts that caused it could not be mentioned, especially not in “polite company”.  Rape?  Never a polite topic.

PTSD that’s Not Military – Civilian PTSD – Damaged People

Many, many people with PTSD are not military.  Most of the women who have been threatened or physically attacked and developed PTSD are not soldiers.  They’re ordinary, everyday people.  Just watch the evening news and it’s obvious that there is no shortage of tragic events in our world and no shortage of evildoers.  Or, maybe, decide not to watch the evening news.  Every misfortune reported likely involves trauma and a victim. 

The Military Is Still a Consistent Producer of PTSD

It’s difficult to find good numbers to compare how common PTSD is in civilian life vs. the military.  By and large, people still believe that PTSD is mainly a military problem.  It’s clear that many individuals with PTSD are military and, in history, have been military.  Just considering soldiers in the US since World War II, there’s the Vietnam war, the battles in Lebanon, the Persian Gulf War, the ongoing conflicts with extremists in Afghanistan, and the continuing struggle to prevent ISIS from overtaking Iraq.  We’ve probably missed one or two additional military operations that have occurred.  It’s a conflict-driven, battle-raging, war-weary world. 

Current PTSD Treatments are Good and Better Treatments are Coming All The Time

There are medicines commonly used with good success and therapy treatments that work for PTSD.  Go see a doctor and he/she can treat your PTSD.  But having said that, it’s not as though everyone who has PTSD gets well and everything is great.  We need medicines and treatment that we can count on for PTSD.  The good news is that the hunt for new and better ways, both medicines and therapy, is a hot area of science in the Western world.  The search for new medications for PTSD is an active area of medical discovery.  The search is also on for new non-medicine therapies for PTDS.  People are also avidly interested in learning the best ways to combine medicines and therapies in a “one-two punch”.

There Is Not One PTSD Treatment That Works for Everyone – You Need a Plans for YOU

Every person, civilian or military, with PTSD has his/her own story and his/her own special needs.  As a result, every treatment plan must be custom designed for that one specific individual.  There is no single best treatment that works for everyone.  So, the best hope for success for you is a care plan made with you in mind.

Medicines for PTSD Treatment

The medicines we have now do help.  Many times a person with PTSD is so upset, fearful, and angry that thinking about a plan for “therapy” or “psychotherapy” just adds to the frustration and makes things worse.  Such a situation might call for trying a medicine first.  Taking the medicine that seems like the best choice for a while can help lessen the PTSD symptoms just enough so that maybe therapy will seem okay or might not even be needed.  But therapy is a good, effective path to take.  Usually the combination of a good medicine and helpful therapy is the most powerful and fastest way to get better.

Medicine Choices for PTSD Treatment

Not every individual with PTSD is depressed.  So it surprises people with PTSD when the first medicine suggested to them is a medicine for depression.  While these medicines do work to correct the brain changes of depression, they also work to correct the brain changes of PTSD whether you’re depressed or not.  The type of medicine often tried first is the SSRIs, selective serotonin reuptake inhibitors.  In fact, the SSRIs sertraline (Zoloft) and paroxetine (Paxil) are both approved by the FDA for PTSD.  There are other SSRIs to try, like, for example, fluoxetine (Prozac).  If a trial of 1 or 2 SSRIs doesn’t help, there are other choices.  Some are newer medicines and others are older medicines that have been used for a long time and are known to work and to be safe.

The Nightmares of PTSD

Nightmares are often a part of PTSD, and there are medicines that usually work to decrease these nightmares.  Prazocin (Minipress, Vasoflex, Lentopres, Hypovase) seems to be everyone’s favorite medicine to use first for PTSD nightmares.

More Medicines

If the medicines mentioned above don’t seem to work for you, there are other medicines to try that might help and are certainly worth trying.  There is, for example, the whole family of “mood stabilizer” medicines, such as lithium, valproate, lamotrigine, or carbamazepine.  Another class of medicine, one that was originally developed for psychosis, can have a good effect on PTDS.  Quetiapine and aripiprazole are two such medicines.  They work best when they are not used by themselves but instead are added to another medicine like an SSRI.  A general calming medicine that is sometimes used is clonidine.

New Medicine Ideas for PTSD Treatment

There are new ideas for medicines for PTSD treatment coming down the pike.  After several small studies showed that psychedelic drugs might have in treating PTSD the FDA granted one a “Breakthrough Therapy” designation  See our page on Psychedelics for PTSD. 

Non-Medicine Therapy

There are several types of therapies that can be really helpful.  For example, there are education-based therapies, experiential therapies that rely on experiences, psychotherapies or “talk therapies”, occupational therapies that focus on how to do specific tasks, and rehabilitation therapies that work on getting back to some better way to live.  Some education-based therapies were designed to teach people what PTSD is all about.  Others go further into the why and the how of getting PTSD symptoms to go away.

When You Pick Your Therapist You Pick Your Therapy

Most clinicians who do therapy have their favorite “brand” of therapy that they use on all their clients.  Because of this, if you don’t like the approach of one therapist you probably need to find and try a different therapist to get a different therapy.  Some people are of the opinion that, for PTSD, therapy is better than medicine.  Their opinion is that if you’re getting psychotherapy from a good therapist you don’t need medicine.  This is usually not true, and the combination of a good medicine and a helpful therapy is often the best and quickest way to get PTDS to stop.

Helpful links

ClinicalTrials.gov has 230 studies recruiting or to be recruiting for PTSD (as of 3/5/2020).

Post-Traumatic Stress Disorder – National Institutes of Health

PTSD Treatment Programs – U.S. Department of Veterans Affairs

Post-traumatic stress disorder (PTSD) – The Mayo Clinic

Causes of PTSD by Tyler Merchant DO at Elevate Holistics

Treatment for PTSD – Anxiety and Depression Association of America

Posttraumatic Stress Disorder – National Alliance on Mental Illness

A New and Better View – PTSD is an Injury not a Disorder

There is a new and beneficial movement arising. Many realize that the effect of trauma on a person is an injury. If the trauma is shrapnel hitting an arm, a bone might be broken. It’s an injury. If the trauma is the fear of death from a rapist, the brain in injured. It’s a physical, brain-based injury, a stress injury resulting from a major trauma. With the shrapnel we don’t call it a broken bone disorder. It’s a broken bone, an expected injury. With the rape, the victim’s brain is injured. It’s an injury, not a disorder. The slow-moving American Psychiatry Association’s DSM-5 has not yet made this change. DSM-5 did move PTSD from the Anxiety Disorders category to the Trauma and Stressor-Related Disorder category because PTSD can bring anger, guilt, and shame, not just anxiety.

If PTSD is an Injury Why Are Some People Injured and Some Are Not?

This isn’t a mystery. Let’s go back to the shrapnel and broken arm bone example. If Arnold Schwarzenegger’s arm bone is hit by the shrapnel it might be less likely to be broken. If basketball player Manute Bol’s bone is hit, it’s more likely to shatter. (Manute Bol is 7 feet 7 inches [2.3 meters] tall and weighs only 225 pounds [102 kg]. He’s real, real skinny.) Similarly, if someone’s brain makeup is such that it’s more resistant to trauma, the individual’s brain might be less injured by a trauma. If their brain is more susceptible, the resulting damage would be much worse. Many are arguing that it should be called PTS, Post-Traumatic Stress, not PTSD. It’s an injury, so drop the “Disorder”.

Post-Traumatic Stress Disorder Can Be Successfully Treated

To start on a positive note, PTSD can be successfully treated. There are trained expert doctors who can treat PTSD. The most sure-fire reliable treatment plan is to pursue both medication and therapy. (See our free page on PTSD – Effective Treatments.) There are highly effective medications for PTSD (some better than others) and skilled and conscientious therapists who are experts on PTSD (again, some better than others). It’s important to keep in mind that PTSD is an area where one size does NOT fit all. Get the medicine and therapy fit right and things will do well.

Post-Traumatic Stress Disorder – Dread that Lingers

The cause of PTSD is a traumatic experience or a series of them. PTSD can start right after the damaging event, or sometime later. Maybe a few days, or weeks, or even months later. That’s when the ongoing hurt starts. Man or woman, soldier or civilian, PTSD can hit anyone because any of us can be hit by some trauma. Life is long, and at points along the way fate can suddenly twist our world. The severity of the stressful events causes brain and body changes. People don’t quickly recover from this type of damage. There’s not at automatic recovery, like from the common cold.

A Reader Asks:

My uncle was in the U.S. Army in Afghanistan from 2006 to 2008. He came back a broken man and works but at a job way below his capabilities. He seems angry a lot of the time. How long can PTSD last?

If a person with PTSD does not get medical care, the PTSD can last for many years, at times for the rest of his life. It might appear to be worse at some times and less bad at other times. It can happen that PTSD symptoms gradually fade over time. It’s far better to seek treatment. As we say above, the most reliable treatment plan one with both medication for the PTSD and therapy to help with symptoms and coping with life.

About Medical Care for PTSD

Yes, there are skilled therapists and yes, there are good medications. But even with these great tools there’s no way to force a person into treatment. One speed bump on the path to care is that there are people with PTSD who feel so damaged that they say they don’t want help. They can’t let anyone, not even a doctor, into their life. These are individuals who have been hit hard and broken badly. What they have been through has changed them, changed their brain, changed their body. They feel vulnerable. They protect themselves by putting up hard, high walls. Walls no one can break through. They do need treatment, and treatment will work, but they just can’t do it, at least not now, at least not yet.

Finding the Right People Who Can Help with PTSD

If you are a person with PTSD, you need to see a doctor who can prescribe medication, in case medication is needed. And, you need a skilled individual who can listen, and can help with therapy and education about PTSD. In addition, this skilled clinician has to be someone with whom you can “connect”. That is, someone whom you can trust and with whom you feel comfortable. Someone who is “authentic” and real. These abilities and traits might all be found in one person or in one or two or three clinicians. Or, maybe found in a skilled PTSD treatment team in a clinic.

It Seems Danger Could Lurk Down Any Street or Around Any Corner

There’s a long list of the many types of threatening, overwhelming, and damaging events and experiences that can trigger PTSD. The battles, dangers, and threats of war are obvious examples. Then there’s physical abuse, getting battered by someone, at any point in life. An example is being mugged in one of our violent city centers. Even random shootings and terrorist attacks. Psychological and/or emotional abuse can damage just as powerfully as a physical hits. Domestic violence, to be hurt by family, is far too common, as is sexual abuse, so intimate and appalling. Near rape and rape are on the list. And severe traffic crashes. Add to the list natural disasters like tornados, fires, earthquakes, hurricanes, and floods. There seems no end to the list of tragedies that can plunge any one of us into PTSD.

An Even Worse Form – Complex Post-Traumatic Stress Disorder (C-PTSD)

Reading the above description of PTSD might leave one with the impression that it can’t get any worse. But it can. A little over 20 years ago it was realized that there is a more severe form of PTSD. Maybe it’s caused by a worse trauma. Perhaps the cause is repeated trauma over and over for months or years. It could be a certain type of trauma that “pushes buttons”, that causes an individual to crumble inside. Other worse symptoms appear beyond the usual list of signs and symptoms associated with PTSD. C-PTSD is likely harder to treat, but treatment can still end with success.

At Least Now We, As a Society, Admit that PTSD Is a Real, Treatable Medical Condition

Too many soldiers from previous wars never got well. Instead of coming home heroes they came home broken and stayed that way. Shell shock in World War I. Combat stress reaction in World War II. War neurosis. Soldier’s heart. Every war and conflict had its name for what we now call PTSD. Before we knew what to do many with PTSD never got well.

The 3 Faces of PTSD – A Person Can Have One, or Two, or All Three

There are three possible ways that the medical condition of PTSD can look.

• The person can feel that they’re living through the event again
• The individual might stay away from people and places and let their emotions just go numb
• Or, the person might stay constantly alert, too alert, hyperalert, always on watch for a coming attack or to attack if threatened

Let’s take a look at the details.

The 3 Faces of Post-Traumatic Stress Disorder

Living the Traumatic Event Again

Living through the stressful event again includes several types of re-living. There are upsetting memories that can haunt a person. Through the night, nightmares can make even sleep unrestful and no escape. Disturbing flashbacks, the sudden feeling that the trauma is happening again right here and right now, can put the person through hell. They don’t feel vague or distant. They feel real. Then there are the non-proportional reactions. An individual can have a major reaction to some minor reminder of the trauma. To everyone around them, the reminder occurrence might seem small and trivial. For example, the person with PTSD might dive for cover when a car backfires.

Not Wanting “To Go There”

The second broad symptom category of PTDS includes making an effort not to think about the trauma, not letting feelings come up (by pushing feelings down and out of awareness), staying far away from any possible reminders of the trauma, and, finally, just plain really and actually forgetting that it happened. But along the way, the person with PTSD can completely lose interest in life’s important events and relationships and feel like other people don’t matter. They might just be flat or blank as far as emotions are concerned. “Life’s about over,” is another thought that might be present.

If You’re Coming for Me, I’m Ready for You

The third category of presenting symptoms are the “alert” or hyper-alert symptoms. This group of symptoms can include poor sleep, being “edgy” and irritable, and being unexpectedly quick to anger. Another aspect of this area is confusion, that is, being mentally unclear. The person might have trouble just trying to think. Further, he might be always on the alert for trouble, ready to take action. Ready with “a dollar’s worth of response against a nickel’s worth of threat”. Overreacting would be another way to say it.

A Bit of Medical History – PTSD is an Ancient Medical Condition

In 480 B.C.E., the ancient Greek King and Commander Leonidas removed men from Spartan Army combat if he judged that they were too psychologically and emotionally damaged from battle. Leonidas was the King portrayed in the movie 300 about the Battle of Thermopylae. This is the historic battle wherein 300 Spartans fought to the death but successfully held off the 150,000 man Persian army.

Helpful links:

ClinicalTrials.gov PTSD Studies

The National Institutes of Health on PTSD

Department of Veterans Affairs National Center for PTSD

The Mayo Clinic on PTSD

What Is Posttraumatic Stress Disorder by the American Psychiatric Association