Post-traumatic stress disorder (PTSD) is a condition where you have recurring distressing memories, flashbacks and other symptoms after suffering or witnessing a traumatic event. Treatment options include antidepressant medication and non-medicinal treatments such as cognitive behavioural therapy (CBT).
This leaflet is part of our series on anxiety and phobias
Post-traumatic stress disorder (PTSD) is a condition which develops after you have been involved in, or witnessed, a serious trauma such as a life-threatening assault. During the trauma you feel intense fear, helplessness or horror. In some people PTSD develops soon after the trauma. However, in some cases the symptoms first develop several months, or even years, after the trauma.
The strict definition of PTSD is that the trauma you had or witnessed must be severe; for example: a severe accident, rape, a life-threatening assault, torture, seeing someone killed, etc. However, symptoms similar to PTSD develop in some people after less severe traumatic events.
It is estimated that up to 3 in a 100 people may develop PTSD at some stage in life. One large survey of the general population in England found that 3 in 100 adults screened positive for PTSD.
It is much more common in certain groups of people. For example, some studies have found that PTSD develops in about:
Some people have risk factors which make them more prone to develop PTSD when they are exposed to a traumatic event. These include:
Note: it is normal to feel upset straight after a traumatic event. But for many people the distress gradually eases. If you have PTSD the distressing feelings and symptoms persist. In some cases the symptoms last just a few months and then ease or go. However, in some cases the symptoms persist long-term.
Up to 4 in 5 people with PTSD also have other mental health problems; for example, depression, persistent anxiety, panic attacks, phobias, drug or alcohol abuse.
Having a mental health disorder before the trauma seems to increase your chance of developing PTSD. But also, having PTSD seems to increase your risk of developing other mental health disorders.
You may need no treatment if your symptoms are mild, particularly if the trauma happened less than a month ago. However, if your symptoms are prolonged and moderate or severe, treatment can help you to adjust. If you have severe symptoms 2-4 weeks after the incident, you are likely to need treatment.
You should be aware that no treatment will 'wipe the slate clean' and erase all memories of the event.
Note: some non-medicinal treatments mentioned below may not be available on the NHS in every area.
Antidepressant medicines are often prescribed. These are commonly used to treat depression but have been found to help reduce the main symptoms of PTSD even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing symptoms.
Antidepressants take 2-4 weeks before their effect builds up and can take up to three months. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give an antidepressant time to work. If one does help, it is usual to stay on the medication for 6-12 months, sometimes longer.
There are several types of antidepressants. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for PTSD. There are various types and brands of SSRI. Paroxetine has been found to be particularly useful for general use. Non-SSRI medicines sometimes used by specialists are mirtazapine and phenelzine.
Benzodiazepines such as diazepam are sometimes prescribed for a short time to ease symptoms of anxiety, poor sleep and irritability. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not used long-term. A short course of up to 2-3 weeks may be prescribed now and then if you have a particularly bad spell of anxiety symptoms.
Other medicines such as beta-blockers, mood stabilisers and anticonvulsants are being studied. These are normally used to treat other conditions but there is some evidence that they may help some people with PTSD. Further research is needed to clarify their role.
A combination of treatments such as CBT and an SSRI antidepressant may work better in some cases than either treatment alone.
Doctors and patients can use Decision Aids together to help choose the best course of action to take.Compare the options for Post-traumatic Stress Disorder.
Family and friends can:
Debriefing used to be offered to people affected by natural disasters, etc. It is no longer considered effective for individuals but has been found useful for selected groups (eg, emergency workers before going back to work in stressful situations). No other treatment or medication is yet approved to prevent people from developing PTSD should they be exposed to a traumatic event; however, a medicine called clonidine is showing promising results in research studies.
Screening is appropriate for people who have been subjected to major disasters and for asylum seekers and refugees.
Statistics show that about 2 in 3 people with PTSD eventually get better without treatment, although the improvement may take several months. In about 1 in 3 people the symptoms last longer, sometimes for many years and can be quite severe in some people. The response to treatment can vary from person to person.