Over their lifetime, up to seven in 10 adults in the United States will directly experience or witness upsetting events. These include gun violence, car accidents and other personal traumas, natural or man-made disasters such as Hurricane Katrina and the 9/11 terrorist attacks, and military combat. And some — though not all — will experience posttraumatic stress disorder, or PTSD.
New guidelines to be released in 2024 may help find effective treatment.
What is PTSD?
PTSD is a potentially debilitating mental illness. It is characterized by recurrent, frightening episodes in which a person relives a traumatic event.
After a disturbing event, it is normal to have upsetting memories, feel nervous, and have trouble sleeping. For most people, these symptoms go away over time. However, if certain symptoms persist for more than a month, a person may have PTSD.
These symptoms include:
recurring nightmares or intrusive thoughts about the event
feeling emotionally numb and disconnected
withdrawing from people and certain situations
feeling nervous and on guard.
The National Center for PTSD offers a short online self-assessment test that can help you decide if you should seek more information and help.
Who is more vulnerable to PTSD?
Not everyone who experiences violence, disasters, and other upsetting events later develops PTSD. However, military personnel who fight in a war zone are particularly at risk. According to the National Center for PTSD, about 11% to 20% of veterans who served in Iraq or Afghanistan suffer from PTSD.
What about people who were not in the military? Within the general population, it is estimated that 4% of men and 8% of women suffer from PTSD—a difference that is at least partly related to the fact that women are more likely to be victims of sexual assault.
What are the new guidelines for treating PTSD?
Experts from the U.S. Department of Veterans Affairs and the U.S. Department of Defense have collaborated to develop new guidelines for treating PTSD. They have detailed the evidence for and against specific therapies for PTSD.
Their findings apply equally to civilian and military personnel, says Sofia Matta, MD, a psychiatrist at Harvard-affiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit that cares for veterans, military members and their families.
The circle of care is drawn broadly for good reason. “It’s important to recognize that PTSD affects not only the person suffering, but also their families and sometimes their entire community,” Dr. Matta says. The rise in mass shootings in public places and the aftermath of these events is a grim reminder of that reality, she adds.
What treatment approaches are most effective for PTSD?
The new guidelines addressed psychotherapy, medication and non-drug therapies. Psychotherapy, sometimes in combination with certain medications, was found to be the most effective approach.
The experts also recommended not taking certain medications because there was no evidence to support them or there was potential harm.
What psychotherapies are recommended for PTSD?
The recommended treatment for PTSD, psychotherapy, is more effective than medications. It also has fewer side effects and is preferred by people, according to the guidelines.
What type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD are different from those for people with other mental health problems, says Dr. Matta.
Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the disturbing thoughts that result from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning and simple yoga stretches.
What medications are recommended for PTSD?
Some people with severe symptoms need medication to feel well enough to attend therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Dr. Matta.
Three medications commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak.
What medications are not recommended for PTSD?
Guidelines strongly advise against taking benzodiazepines (anti-anxiety drugs often taken to help you sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefit for people with PTSD. They have several potential harms, including negative cognitive changes and reduced effectiveness of PTSD psychotherapies.
What about cannabis, psychedelics, and brain stimulation therapies?
Currently, the evidence does not support the notion that cannabis relieves PTSD symptoms. And the drug can have severe side effects, such as cannabis hyperemesis syndrome (severe vomiting associated with long-term cannabis use).
There is not enough evidence to argue for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the hurdles to conducting research on them are very high,” says Dr. Matta. However, recent legal reforms may make such studies more feasible.
Similarly, the evidence is mixed for a wide range of other non-drug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation.