Post-Traumatic Stress Disorder (PTSD) Treatments

The diagnostic criteria for PTSD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is a widely used classification system for mental health disorders. To receive a diagnosis of PTSD, an individual must meet the following criteria:

• Exposure to Trauma: The person must have been exposed to or directly experienced a traumatic event involving actual or threatened death, serious injury, or sexual violence. They may have also witnessed such an event happening to others, learned about the traumatic event happening to a close family member or friend, or been repeatedly exposed to distressing details of traumatic events (such as first responders).
• Intrusive Symptoms: The person must experience one or more intrusive symptoms related to the traumatic event. These symptoms include recurrent and distressing memories, nightmares, or flashbacks.

• Avoidance: The individual avoids trauma-related stimuli, such as thoughts, feelings, people, places, or activities associated with the traumatic event.
• Negative Mood and Cognition: The person may experience negative thoughts or feelings that began or worsened after the trauma. They may have difficulty remembering important aspects of the event or have overly negative beliefs about themselves or the world.
• Changes in Arousal and Reactivity: The person may display changes in arousal, such as irritability, aggression, reckless behavior, or difficulty concentrating. They may also experience increased hypervigilance or an exaggerated startle response.
• Duration: The symptoms must persist for more than one month.
• Functional Impairment: The symptoms must cause significant distress or functional impairment in various areas of the individual’s life, such as work, relationships, or social activities.

Post-Traumatic Stress Disorder (PTSD) can be treated with medications as part of a comprehensive treatment plan. Medications are often prescribed to manage the symptoms associated with PTSD, but it’s important to note that they are typically used in conjunction with therapy and other forms of support. The specific medications prescribed may vary based on the individual’s symptoms and overall health.

Here are some common types of medications used in the treatment of PTSD:

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are a class of antidepressant medications that increases the levels of serotonin in the brain. They are often used to treat symptoms of depression, anxiety, and intrusive thoughts in PTSD. Common SSRIs used for PTSD include sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac).
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs are another type of antidepressant that increases levels of serotonin and norepinephrine in the brain. They can help with symptoms of depression and anxiety in PTSD. Venlafaxine (Effexor) is an example of an SNRI used for PTSD.
• Mirtazapine: Mirtazapine (Remeron) is an antidepressant that targets both serotonin and norepinephrine systems. It is sometimes used in PTSD to target depression, insomnia, and appetite loss. It may be especially helpful in individuals who cannot tolerate SSRIs or who experience significant sleep disruption.

• Trazodone: Trazodone is an antidepressant often used off-label in PTSD to treat insomnia and nightmares. While its antidepressant effects are modest, it is frequently prescribed in low doses in an effort to improve sleep quality without the risks associated with benzodiazepines.

• Prazosin: Prazosin is a medication originally used to treat high blood pressure, but it has shown promise in reducing nightmares and sleep disturbances associated with PTSD by blocking certain receptors in the brain related to adrenaline responses.
• Clonidine & Guanfacine: These blood pressure medications are sometimes used to reduce the “fight or flight” response, which can make it easier to sleep, concentrate, and feel less on edge. Clonidine and guanfacine may be considered in children, adolescents, or adults with comorbid conditions like ADHD that cause restless hyperactivity.
• Hydroxyzine: Hydroxyzine is an antihistamine with anxiety-reducing properties. It may be used short-term to manage acute anxiety or insomnia in PTSD.
• Atypical Antipsychotics: In some cases, atypical antipsychotic medications may be prescribed off-label to help manage severe anxiety, aggression, or dissociative symptoms associated with PTSD. Medications like quetiapine (Seroquel) or risperidone (Risperdal) are examples of atypical antipsychotics that might be used.

It’s essential to work closely with a qualified mental health professional, such as a psychiatrist or a psychiatric nurse practitioner, to determine the most appropriate medication and dosage for an individual’s specific needs. Each person’s response to medication can vary, so close monitoring is crucial to assess its effectiveness and manage any potential side effects.

PTSD is typically treated with therapy, medication, or a combination of both. While many people benefit from these approaches, some do not fully respond.

Research suggests that up to one-third of individuals with PTSD may be resistant to standard treatments, particularly those with complex or long-standing trauma.

The demand for more innovative PTSD treatments arises from the recognition that existing treatment approaches may not fully address the complexities of this debilitating condition.

Some of the most promising and innovative treatments that are being studied and implemented include:

• Ketamine-assisted therapy: Ketamine-assisted therapy (often called Ketamine infusions) has shown promise as a potential treatment for PTSD. Ketamine is a dissociative anesthetic that, when administered at lower doses, can sometimes produce rapid and profound changes in mood and perception. It targets the brain’s glutamate receptors, which are involved in mood regulation and the processing of traumatic memories.

  During ketamine infusions for PTSD treatment, a carefully controlled dose of ketamine is delivered intravenously under medical supervision. Individuals may experience a temporary dissociative state or altered perception during the infusion, but this is closely monitored by healthcare professionals.

  For some, Ketamine may rapidly alleviate symptoms of depression, anxiety, and distress associated with PTSD. It can induce a sense of emotional detachment, allowing individuals to approach their traumatic memories with reduced fear and emotional reactivity. This creates an opportunity for them to process and reframe these memories in a more adaptive and less distressing way.

  Studies have shown that for some, ketamine infusions can lead to significant reductions in PTSD symptoms, including nightmares, flashbacks, and hyperarousal, often within hours or days after treatment. Its reputation for rapid onset is particularly advantageous for individuals who have not responded well to traditional therapies or who require immediate symptom relief. While ketamine infusions may reduce symptoms quickly, the duration of the effect is often short-lived, and ongoing treatment with psychotherapy is recommended.

• MDMA Therapy: MDMA-assisted therapy for PTSD, also known as MDMA therapy or psychedelic-assisted therapy, is an investigational approach to treating Post-Traumatic Stress Disorder (PTSD). It involves the supervised use of MDMA, commonly known as ecstasy, in combination with psychotherapy to assist individuals in processing and healing from traumatic experiences. MDMA therapy is still being evaluated for FDA approval.

• Stellate ganglion block: Stellate ganglion block (SGB) is an experimental procedure that involves injecting a local anesthetic into the stellate ganglion, a cluster of nerves located in the neck. The stellate ganglion is part of the sympathetic nervous system, which plays a role in the body’s stress response. The injection aims to block or interrupt the transmission of nerve signals from the stellate ganglion to the brain.

  Individuals with PTSD may have an overactive sympathetic nervous system, which contributes to the intense stress responses and hyperarousal commonly seen in the condition. By temporarily blocking the stellate ganglion, the procedure aims to interrupt the hyperactivity of the sympathetic nervous system, leading to a reduction in PTSD symptoms.

  It is important to note that while SGB shows promise as a potential treatment for PTSD, more research is needed to fully understand its safety, long-term effectiveness, and the specific mechanisms by which it provides relief.

LifeStance actively monitors emerging treatment innovations and does offer Ketamine therapy in select U.S. States. Additional innovations may be available in the future.

We provide a wide range of evidence-based therapies and medication treatments for PTSD. Our trauma-informed therapists and psychiatric clinicians offer both in-person and virtual care.

Get matched with a provider today to explore a treatment plan that fits your needs.