Post-traumatic stress disorder: What to know as FDA weighs MDMA therapy

Here’s what to know about PTSD.

Post-traumatic stress disorder develops in some people after experiencing a shocking, scary or dangerous event, according to the National Institute of Mental Health.

“People may experience a range of reactions after trauma, and most people recover from initial symptoms over time,” NIMH says. But those who continue to experience difficulties may be suffering from PTSD, it adds.

The National Center for PTSD describes it as a mental health condition that can develop at any age. Personal circumstances and factors such as age and gender can affect whether people develop PTSD, the center says, adding that PTSD is common after combat or sexual assault trauma. Social support after a traumatic event can make it less likely for a person to develop PTSD.

Mapping the incidence of PTSD is not easy, the center says, for various reasons including a lack of diagnosis. About 13 million Americans had PTSD in 2020, the center estimates, and more women than men will experience PTSD during their lifetime.

Symptoms typically surface within three months of the trauma, NIMH says, and must occur for more than a month, as well as interfere with functioning of daily life, to be diagnosed as PTSD.

There are four types of PTSD symptoms and a person needs to experience symptoms from each category for a diagnosis.

The first category, reexperiencing symptoms, are those in which the traumatic event is relived, such as in flashbacks or dreams. Objects or thoughts can trigger such reminders.

Avoidance symptoms involve staying away from situations, places, people or thoughts that serve as a reminder of the trauma.

The third type, known as arousal and reactivity symptoms, include feeling edgy, tense or having sleep or concentration problems.

Lastly, cognition and mood symptoms can lead to negative feelings of fear, anger, guilt or shame. They can also lead to social isolation.

The main treatments are psychotherapy, medications or both, according to the NIMH.

Psychotherapy can include exposure therapy and cognitive restructuring. The former focuses on gradually exposing patients to their fear. Therapists may ask patients to write about their trauma, or visit the places of the trauma. Cognitive restructuring is aimed at persuading patients to rethink their trauma. “Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault,” according to the NIMH.

Treatment may also focus on tackling the symptoms of PTSD, such as panic disorder, depression, substance use or suicidal thoughts. Support from family and friends can facilitate recovery.

The U.S. Defense Department and Veterans Affairs Department advise patients to utilize psychotherapy as “first-line treatments for PTSD” over medications, though medications can be effective in the absence of psychotherapy treatment options.

What are the medications available?

The FDA has approved only two drugs for treating PTSD: sertraline and paroxetine. They are selective serotonin reuptake inhibitors, also referred to as SSRIs.

SSRIs may help manage symptoms such as sadness, worry or anger, according to the NIMH.

Sertraline increases the levels of serotonin, a mood-enhancing chemical, in the brain. Paroxetine, a type of antidepressant, usually requires four to six weeks to fully work, according to Britain’s National Health Service. Side effects may include feeling sick, or sexual problems, but “are usually mild and go away after a couple of weeks.” It may also affect concentration. “If this happens, it might be best to stop driving, cycling or operating tools or machinery for the first few days until you know how it makes you feel,” the NHS says.

The antidepressant venlafaxine, sold under the brand name Effexor, is “conditionally recommended” by the American Psychological Association, but is a “strongly recommended treatment” option by the Departments of Defense and Veterans Affairs.