Most people go through something frightening at some point: a car accident, an assault, combat, a natural disaster, a medical emergency, or the sudden loss of someone close. Strong reactions in the days and weeks afterward are normal, and for many people they ease with time and support.
When the reactions don't ease, lasting more than a month and getting in the way of sleep, work, or relationships, it may be post-traumatic stress disorder (PTSD). PTSD is common, it isn't a sign of weakness, and it responds well to treatment.
What PTSD can look like
- Reliving it. Unwanted memories, nightmares, or flashbacks that feel like it's happening again.
- Avoiding reminders. Steering clear of places, people, conversations, or even thoughts connected to what happened.
- Changes in mood and thinking. Guilt, shame, anger, feeling detached from others, or losing interest in things you used to enjoy.
- Feeling on guard. Being easily startled, irritable, or tense, with trouble sleeping or concentrating.
Many people also find they're drinking more, or relying on cannabis or other substances, to sleep or take the edge off. That's worth mentioning to your doctor, without judgment, because it affects which treatment fits best.
Therapy is the most effective treatment
Trauma-focused psychotherapy has the strongest evidence for PTSD. The best-studied approaches are:
- Cognitive processing therapy (CPT), which helps you examine and change beliefs that took hold after the trauma, such as "it was my fault" or "nowhere is safe."
- Prolonged exposure (PE), which gradually and safely reduces the power of the memory and of the situations you've been avoiding.
- EMDR (eye movement desensitization and reprocessing), which pairs focused recall of the memory with guided eye movements or other back-and-forth stimulation.
These therapies are usually weekly and time-limited, often about 8 to 16 sessions. Many people notice real change within a few months.
Where medication fits
Medication can help on its own or alongside therapy, especially when symptoms are severe, therapy isn't available yet, or depression and sleep problems are also part of the picture.
- SSRIs and SNRIs are the first-line medications. Sertraline and paroxetine are FDA-approved for PTSD, and venlafaxine is also commonly used.
- Nightmares sometimes improve with prazosin, although studies are mixed, so it's a decision to make together.
- Benzodiazepines such as alprazolam or clonazepam are generally not recommended for PTSD. They don't treat the condition and can make recovery harder.
Medications take several weeks to work, and the right dose varies from person to person, so regular follow-up matters.
How a psychiatrist can help
A psychiatric evaluation looks at the full picture: trauma symptoms, sleep, mood, anxiety, substance use, and any medical conditions. From there, I can manage medication, help you find a trauma-focused therapist, and stay in touch with them so your care is coordinated.
If you're not sure whether to start with a psychiatrist or a therapist, this guide explains the difference. Sleep is often one of the first things to improve with treatment, and this article on insomnia covers what helps.
When to get help right away
If you're having thoughts of harming yourself or ending your life, call or text 988 to reach the Suicide & Crisis Lifeline, or call 911.
This article is general information, not medical advice for your situation. If you're in crisis, call or text 988, or call 911.