PTSD BASICS
Treatments Included in this Decision Aid
This decision aid focuses only on evidence-based treatments that are proven to work. Treatments in this decision aid received a strong recommendation in the 2017 guideline published by the Department of Veterans Affairs and Department of Defense (VA/DoD).
To treat PTSD, the VA/DoD guideline strongly recommends the use of trauma-focused psychotherapies or specific SSRIs and SNRIs (types of antidepressants). Trauma-focused psychotherapies are the most highly recommended type of treatment.
Click any of the treatments below to see a description. You will learn more about all of these options as you continue using the decision aid. However, if these terms are new to you, this will help.
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What about other types of treatments?
There are many other types of treatments for PTSD. Some treatments have been studied and do not appear to be effective for PTSD. Other treatments have not been studied enough to say with certainty whether they work for PTSD. Sometimes people with PTSD may choose to receive a treatment that is not evidence-based, and they may find these treatments are helpful.
This decision aid focuses only on evidence-based treatments because years of research tell us that these treatments offer the best chance of recovery.
What about other treatments?
Watch this video to learn a little bit about the different levels of effectiveness for different types of treatment.
Some PTSD treatments work better than others. The chart below lists different PTSD treatments according to the strength of the recommendation from the Department of Veterans Affairs/Department of Defense.
Medications
- Fluoxetine (Prozac®)Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Paroxetine (Paxil®)Paroxetine is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Sertraline (Zoloft®)Sertraline is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Venlafaxine (Effexor®)Venlafaxine is a serotonin norepinephrine reuptake inhibitor (SNRI) that affects levels of naturally occurring chemicals in the brain called serotonin and norepinephrine. Serotonin and norepinephrine are signaling chemicals that play a role in brain cell communication and influence a person’s mood.
Psychotherapies
- Individual trauma-focused psychotherapies, to include:
- Brief Eclectic Psychotherapy (BEP)A type of trauma-focused psychotherapy. You will practice relaxation skills, recall details of the traumatic memory, reframe negative thoughts about the trauma, write a letter about the traumatic event, and hold a farewell ritual to leave trauma in the past.
- Cognitive Processing Therapy (CPT)A type of trauma-focused psychotherapy that teaches you to reframe negative thoughts about the trauma. It involves talking with a therapist about your negative thoughts and doing writing assignments and worksheets.
- Eye-Movement Desensitization and Reprocessing (EMDR)A type of trauma-focused psychotherapy that helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).
- Narrative Exposure Therapy (NET)A type of trauma-focused psychotherapy developed for people who have experienced trauma from ongoing war, conflict and organized violence. You will talk through stressful life events in order (from birth to the present day) and put them together into a narrative.
- Prolonged Exposure (PE)A type of trauma-focused psychotherapy that teaches you how to gain control by facing your fears. It involves talking about your trauma with a therapist and doing some of the things you have avoided since the trauma.
- Specific cognitive behavioral therapies for PTSD A limited number of psychotherapies shown to work for PTSD where the therapist helps you learn how to change unhelpful behaviors or thoughts.
- Written Narrative Exposure A type of trauma-focused psychotherapy that involves writing about the trauma during sessions. Your therapist gives instructions on the writing assignment, allows you to complete the writing alone, and then returns at the end of the session to briefly discuss any reactions to the writing assignment.
- Brief Eclectic Psychotherapy (BEP)
Medications
- Imipramine (Tofranil®)Imipramine is a tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood. TCA side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- Nefazodone (Serzone®)Nefazodone is a serotonin reuptake inhibitor (SRI) that works by changing the levels and activity of naturally occurring chemical signals in the brain. Cases of life-threatening liver damage have been reported with nefazodone so monitoring for this side effect with blood tests is recommended.
- Phenelzine (Nardil®)Phenelzine is a monoamine oxidase inhibitor (MAOI) which inactivates a naturally-occurring enzyme which breaks down the neurotransmitters serotonin, norepinephrine and dopamine. MAOIs are associated with many drug and diet interactions which can make using them safely challenging.
Psychotherapies
- Interpersonal Psychotherapy (IPT)A psychotherapy that focuses on the impact of trauma on interpersonal relationships.
- Present-Centered Therapy (PCT)A psychotherapy that focuses on current life problems that are related to PTSD.
- Stress Inoculation Training (SIT)A cognitive-behavioral therapy that teaches skills and techniques to manage stress and reduce anxiety.
Medications
- Buspirone (BuSpar®)Buspirone is an antianxiety medication. How it works is not exactly known but it is thought to relate to serotonin and dopamine receptors.
- Bupropion (Wellbutrin®, Zyban®)Buproprion affects mood by boosting levels of the neurotransmitters dopamine and norepinephrine. It is used to treat depression and nicotine addiction.
- Cyproheptadine (Periactin®)Cyproheptadine is a serotonin and histamine blocker used to stop allergic reactions. Side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure. Cyproheptadine may decrease the effectiveness of medications which increase serotonin activity, like selective serotonin reuptake inhibitors (SSRIs).
- Desipramine (Norpramin®)Desipramine is a tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help communication between brain cells and can lift mood. TCA side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- Desvenlafaxine (Pristiq®)Desvenlafaxine is a serotonin norepinephrine reuptake inhibitor (SNRI) that affects levels of naturally occurring chemicals in the brain called serotonin and norepinephrine. Serotonin and norepinephrine are signaling chemicals that play a role in brain cell communication and influence a person’s mood.
- Doxepin (Silenor®)Doxepin is a tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood. TCA side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- D-serineD-serine is a naturally-occurring amino acid that acts as a chemical signal in the brain by activating N-methyl-D-aspartic acid (NMDA) receptors. The NMDA receptor is thought to be important in regulating memory and fear response.
- Duloxetine (Cymbalta®)Duloxetine is a serotonin norepinephrine reuptake inhibitor (SNRI) that affects levels of naturally occurring chemicals in the brain called serotonin and norepinephrine. Serotonin and norepinephrine are signaling chemicals that play a role in brain cell communication and influence a person’s mood. Duloxetine is also used for chronic musculoskeletal pain, diabetic nerve pain, and fibromyalgia.
- Escitalopram (Lexapro®)Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Eszopiclone (Lunesta®)Eszopiclone is a non-benzodiazepine hypnotic which acts on the GABA receptor and causes sleepiness. It is recommended for short-term use only because of problems of dependence and withdrawal, rebound insomnia, memory problems, falls and motor vehicle accidents, and concerning sleep-wake activity.
- Fluvoxamine (Luvox®)Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Hydroxyzine (Vistaril®)Hydroxyzine is a histamine blocker used to stop allergic itching, nausea and vomiting, as well as to reduce anxiety and agitation. Side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- Lovomilnacipran (Fetzima®)Levomilnacipran is a serotonin norepinephrine reuptake inhibitor (SNRI) that affects levels of naturally occurring chemicals in the brain called serotonin and norepinephrine. Serotonin and norepinephrine are signaling chemicals that play a role in brain cell communication and influence a person’s mood.
- Mirtazapine (Remeron®)Mirtazapine is a tetracyclic antidepressant that increases levels in the brain of norepinephrine and serotonin, two naturally-occurring chemicals that impact mood. Mirtazapine can have a side effect of sleepiness, which is helpful for people who have trouble with both their mood and sleeping at night.
- Nortriptyline (Pamelor®)Nortriptyline is a tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood. TCA side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- Prazosin (Minipres®) for nightmaresPrazosin is an antihypertensive which blocks the effects of norepinephrine in the brain. It is used to treat high blood pressure and prostate problems in men. Off-label uses include PTSD nightmares.
- Trazodone (Desyrel®)Trazodone is a serotonin reuptake inhibitor (SRI) that increases the effects of the naturally occurring brain chemical serotonin. At low doses, trazodone causes sleepiness and it is most often used to treat insomnia.
- Vilazodone (Viibryd®)Vilazodone is a selective serotonin reuptake inhibitor that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Vortoxetine (Trintellix®)Vortioxetine is a selective serotonin reuptake inhibitor (SSRI) that affects levels and activity of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Zaleplon (Sonata®)Zaleplon is a non-benzodiazepine hypnotic which acts on the GABA receptor and causes sleepiness. It is recommended for short-term use only because of problems of dependence and withdrawal, rebound insomnia, memory problems, falls and motor vehicle accidents, and concerning sleep-wake activity.
- Zolpidem (Ambien®)Zolpidem is a non-benzodiazepine hypnotic which acts on the GABA receptor and causes sleepiness. It is recommended for short-term use only because of problems of dependence and withdrawal, rebound insomnia, memory problems, falls and motor vehicle accidents, and concerning sleep-wake activity.
Psychotherapies
- Acceptance and Commitment Therapy (ACT)A psychotherapy that helps you create a meaningful life by accepting what is out of your control, clarifying what is truly important, and committing to action.
- Couples TherapyA type of psychotherapy in which a person with PTSD and his or her partner attend therapy sessions together.
- Dialectical Behavior Therapy (DBT)A psychotherapy that teaches you skills to manage stress, regulate emotions, and improve relationships.
- Seeking Safety A psychotherapy that focuses on the present and teaches coping skills to help people attain safety from trauma and substance abuse.
- Skills Training in Affect and Interpersonal Regulation (STAIR)A psychotherapy focused on improving emotion regulation and interpersonal relationship skills.
- Supportive CounselingA unstructured therapy in which the therapist provides support, encouragement, and reassurance to help you deal with emotional distress and life problems.
- Any other psychotherapies not specifically mentioned in this table
Complementary/Integrative Treatments- AcupunctureA practice that involves the insertion of thin needles through your skin at strategic points on your body to reduce pain or treat various health conditions.
- Mantram MeditationA meditation-based intervention that involves silently repeating a word or a phrase (called a “mantram”), thinking or acting intentionally, and purposefully concentrating on one thing at a time.
- MeditationA process of focusing attention on what is happening in the moment and developing nonjudgmental acceptance of the experience.
- Mindfulness MeditationAn open-meditation practice that involves self-acceptance, focusing on breathing, and awareness of surroundings. The meditation may be led by a therapist, or an audio-recording may be used.
- YogaA practice that combines specific body postures and movements, breath control, and simple meditation.
- Any other complementary/integrative treatment not specifically mentioned in this table
Biological Treatments- Electroconvulsive Therapy (ECT)A procedure in which electrodes are placed on the scalp and a controlled electric current is applied to cause a brief seizure in the brain. The procedure takes place while you are under general anesthesia.
- Hyperbaric Oxygen Therapy (HBOT)A procedure that involves breathing pure oxygen in a pressurized room or chamber.
- Repetitive Transcranial Magnetic Stimulation (rTMS)A procedure in which brain activity is influenced by a magnetic field. The magnetic field is created by brief pulses through a coil encased in plastic and held close to your scalp.
- Stellate Ganglion Block (SGB)An injection of local anesthetic into the front of the neck to reduce pain or treat various health conditions. This is also called a sympathetic block.
- Vagal Nerve Stimulation (VNS)A procedure that involves putting a device inside your body to stimulate the vagus nerve with electricity. You have a vagus nerve on each side of your body, extending from your brainstem to your abdomen.
Medications
- Amitriptyline (Elavil®)Amitriptyline is a tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood. TCA side effects include constipation, blurred vision, dry mouth, drowsiness, dizziness, and changes in blood pressure.
- Citalopram (Celexa®)Citalopram is a selective serotonin reuptake inhibitor (SSRI) that affects levels of a naturally occurring chemical in the brain called serotonin. Serotonin is a neurotransmitter that plays a role in brain cell communication and influences a person’s mood.
- Lamotrigine (Lamictal®)Lamotrigine is an anticonvulsant that blocks the release of glutamate and slows the flow of sodium in nerve cells, thereby decreasing their activity. Lamotrigine is used to treat seizures and bipolar disorder. It can cause a rare but serious skin rash.
- Olanzapine (Zyprexa®)Olanzapine is an atypical antipsychotic that acts primarily by decreasing the activity of two neurotransmitters: dopamine and serotonin . It is used to treat schizophrenia, bipolar disorder and depression. Side effects include increased appetite, weight gain, cholesterol level changes, problems with blood sugar regulation, diabetes and heart disease.
- Other atypical antipsychotics (except risperidone)Atypical antipsychotics decrease the activity of two neurotransmitters: dopamine and serotonin. These medications are used to treat schizophrenia, bipolar disorder, and depression. They were developed after conventional antipsychotics, and are called “atypical” because they work in a different way and have different side effects. Side effects include increased appetite, weight gain, cholesterol level changes, problems with blood sugar regulation, diabetes and heart disease. Note: The VA/DoD Clinical Practice Guideline strongly recommends against one specific atypical antipsychotic (risperidone).
- Prazosin (Minipres®) except for nightmaresPrazosin is a medication that blocks the effects of excess stress hormone (norepinephrine) in the brain. This can reduce nightmares associated with PTSD. Prazosin is also used to treat high blood pressure and prostate problems in men.
- Quetiapine (Seroquel®)Quetiapine is an atypical antipsychotic that acts primarily by decreasing the activity of two neurotransmitters: dopamine and serotonin . It is used to treat schizophrenia, bipolar disorder and depression. Side effects include increased appetite, weight gain, cholesterol level changes, problems with blood sugar regulation, diabetes and heart disease.
- Topiramate (Topamax®)Topiramate is an anticonvulsant that is thought to decreases nerve activity by changing the flow of sodium in nerve cells and affecting activity of two opposing chemical signals, GABA and glutamate. Topiramate is used to prevent seizures and headaches. It is also being tested in substance use disorders, including alcoholism.
Psychotherapies
- none
Medications
- BenzodiazepinesBenzodiazepines are anticonvulsant medications which enhance the effect of GABA, a neurotransmitter important in regulating nerve activity and feelings of worry and fear. They provide short-term relief of anxiety and insomnia, but regular use is not recommended because of dependence, withdrawal, addiction, worse COPD and sleep apnea, memory problems, confusion, falls, and accidents. There is risk of overdose and accidental death when benzodiazepines are combined with alcohol or strong pain medication (opioids). Examples include: alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and temazepam (Restoril®).
- CannabisCannabis, also called marijuana, is derived from the cannabis plant (cannabis sativa). Cannabis is sometimes prescribed to reduce nausea, improve appetite, or treat chronic pain. Common side effects include dizziness, sleepiness, vomiting, and hallucinations. Long-term side effects may include tolerance, dependence, withdrawal syndrome, psychosis, memory problems, and respiratory symptoms if smoked.
- D-Cycloserine (Seromycin®)Cycloserine is an antibiotic which also interacts with the N-methyl-D-aspartic acid (NMDA) receptor in the brain. The NMDA receptor is thought to be important in regulating memory and fear response. D-cylcoserine has been studied in combination with exposure therapy to treat phobias, panic disorder and obsessive-compulsive disorder.
- Divalproex (Depakote®)Divalproex is an anticonvulsant that appears to work by increasing the action of the neurotransmitter GABA, which decreases nerve activity. Used for seizures, bipolar disorder, and migraine headaches. Valproate risks include serious liver, pancreas, blood cell problems. Use is not recommended in pregnant women. Other problems include nausea, dizziness, tremor and hair loss.
- Guanfacine (Tenex®)Guanfacine is an antihypertensive that reduces nerve activity in the brain. It is used to treat attention deficit hyperactivity disorder (ADHD) and high blood pressure.
- Hydrocortisone (Anusol-HC®)Hydrocortisone is a naturally occurring steroid which is used to decrease inflammation and allergic reactions or to boost the body’s response to stress.
- Ketamine (Ketalar®)Ketamine is a general anesthetic used for surgical procedures and pain management. It is thought to block the N-methyl-D-aspartic acid (NMDA) receptor in the brain which may have a role in regulating memory and fear response.
- Risperidone (Risperdal®)Risperidone is an atypical antipsychotic that acts primarily by decreasing the activity of two neurotransmitters: dopamine and serotonin. It is used to treat schizophrenia and bipolar disorder. Side effects include increased appetite, weight gain, cholesterol level changes, problems with blood sugar regulation, diabetes and heart disease.
- Tiagabine (Gabitril®)Tiagabine is an anticonvulsant that appears to increase the activity of the neurotransmitter GABA. It is used to prevent seizures.
Psychotherapies
- none
*table does not list treatments recommended over no treatment.
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