PTSD — post-traumatic stress disorder

What PTSD looks like

PTSD develops after a traumatic event — one you experienced directly, witnessed, or learned happened to someone close to you. The diagnosis includes four kinds of symptoms:

• Intrusion — flashbacks, nightmares, intrusive memories, intense distress when something reminds you of the trauma.
• Avoidance — avoiding people, places, conversations, or thoughts that remind you of what happened.
• Negative changes in mood and thinking — persistent low mood, distorted beliefs about yourself or the world, emotional numbness, loss of interest, difficulty experiencing positive feelings.
• Hyperarousal — being on edge, easily startled, irritable or angry outbursts, sleep problems, hypervigilance, difficulty concentrating.

To meet diagnostic criteria, these symptoms have to last more than a month and cause meaningful impairment. PTSD can develop right after the trauma or months and years later.

Common sources of trauma we see

• Military combat or military sexual trauma
• Sexual assault or childhood sexual abuse
• Physical violence, including intimate partner violence
• Serious accidents and medical events
• Sudden loss of loved ones
• Childhood emotional or physical abuse or severe neglect
• Witnessing violence or death
• Healthcare workers and first responders — cumulative occupational trauma

We see patients from the U.S. Naval Submarine Base in Groton, healthcare workers from Lawrence + Memorial Hospital, and other community members whose trauma exposure is part of their professional life.

How we treat PTSD

Trauma-focused therapy

The treatments with the strongest evidence for PTSD are trauma-focused therapies. We can deliver some of these at Northline; for the more intensive trauma protocols we partner with specialty trauma providers in Connecticut.

• Cognitive Processing Therapy (CPT) — structured 12-session approach focused on the beliefs about yourself and the world that the trauma created or distorted.
• Prolonged Exposure (PE) — gradual revisiting of the traumatic memory in a safe setting until it loses its grip.
• EMDR (Eye Movement Desensitization and Reprocessing) — structured trauma processing using bilateral stimulation. Often a referral when this is the right fit.

Medication

SSRIs and SNRIs — particularly sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) — have FDA approvals or strong evidence for PTSD. Prazosin can specifically help with nightmares. We sometimes use other medications for specific symptom clusters (sleep, hyperarousal).

We approach controlled-substance use very carefully in PTSD — benzodiazepines specifically are not recommended because they can worsen the long-term course.

Coming later: MDMA-assisted therapy

MDMA-assisted therapy for PTSD is working its way through FDA approval. The first submission was sent back for additional Phase 3 data. The developer is preparing to resubmit. If and when MDMA-assisted therapy is approved, it will be one of the most significant new options for PTSD in decades. We’re tracking the timeline and preparing to deliver it as soon as the regulatory pathway opens.