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Treatment of Post-traumatic stress disorder

It is important for effective treatment that the individual and their family understand that PTSD is a medically recognised anxiety disorder that occurs in some individuals under extremely traumatic conditions. Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan tailored to the needs of the individual. PTSD is treatable even when problems are present many years after the traumatic event.

NICE (National institute for clinical excellence) published guidelines (Spring 2005) on the treatment of PTSD.

  • Mild symptoms of less the 4 weeks- watchful waiting
  • Everyone else should be offered trauma- focused CBT or EMDR on an individual outpatient basis.
  • Children and young people should be offered trauma- focused CBT adapted for their age and circumstances.
  • Drug treatments should not be used as a routine first- line treatment in preference to trauma focused psychological treatment, but should be considered in adults who do not wish to take part in psychological treatment. 
  •  â€˜Debriefing sessions’ (single sessions focusing on the traumatic incident) should NOT be routine practice. All disaster plans should have a planned psychological response to a disaster with health care workers having clear responsibilities agreed in advance.     

PTSD is treated by a variety of forms of psychotherapy and drug therapy.

  • Cognitive-behavioural therapy (CBT): Where skills that change negative thought processes are learnt and exposure to mental imagery of the traumatic event help the individual work through the trauma and to gain control of the fear and distress.
  • Eye Movement Desensitisation and Reprocessing (EMDR): This involves making several sets of side-to-side eye movements while recalling a traumatic incident. This appears to help reduce distress for many with PTSD. It is uncertain, how long the reduction of PTSD symptoms lasts using EMDR.
  • Drug Therapy:  The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitor (SSRI) such as paroxetine. These medications may also be prescribed to help reduce associated symptoms of depression and anxiety and help ease sleep. SSRIs should not be prescribed to the under 18s, although fluoxetine can be used if specialist advice is obtained. Benzodiazepines are effective against anxiety, insomnia and irritability, but are now used with great caution because of the high incidence of substance dependence in patients with PTSD. These drugs can however rapidly relieve any feelings of anxiety triggered by PTSD.

Other disorders commonly co-occurring with PTSD include: depression, alcohol/substance abuse, panic disorder, and other anxiety disorders. Best treatment results are achieved when both PTSD and the other disorders are treated together.