PTSD is a treatable condition that follows trauma, marked by intrusive memories, avoidance, negative mood and hyperarousal lasting more than a month. First-line treatments are trauma-focused therapies (prolonged exposure, cognitive processing therapy, EMDR) and SSRIs such as sertraline and paroxetine, with prazosin for nightmares. Most people improve meaningfully within three to four months of consistent treatment.
Stedfast Psychiatry treats PTSD with the two approaches that have the strongest evidence: trauma-focused psychotherapy and medication. Several of our offices serve large military and veteran communities in Jacksonville, Goose Creek, Melbourne and the Treasure Coast, and we coordinate with VA care when patients want us to. You do not need to tell the story of what happened at the first visit to begin getting help.
Symptoms of PTSD
- Intrusive memories, flashbacks or nightmares about the event
- Intense distress or physical reactions to reminders
- Avoiding people, places, conversations or thoughts connected to the trauma
- Persistent negative beliefs about yourself, others or the world
- Guilt, shame, fear or anger that does not lift
- Feeling detached from others or unable to feel positive emotions
- Being constantly on guard or easily startled
- Irritability, angry outbursts or reckless behavior
- Trouble sleeping and concentrating
- Symptoms lasting more than one month after the event
Causes and risk factors
PTSD requires a traumatic event, but most people exposed to trauma do not develop it. The risk depends on the severity, duration and nature of the trauma (interpersonal violence carries the highest risk), prior trauma, especially in childhood, family history of anxiety or depression, lack of support afterward, and ongoing stress. Biologically, PTSD involves an overactive fear circuit (amygdala), a weakened ability of the prefrontal cortex to signal safety, changes in the stress hormone system, and a memory that was encoded under extreme arousal and never fully processed into the past. Treatment works by giving the brain the chance to finish that processing and by lowering the baseline alarm.
About 3.6 percent of US adults had PTSD in the past year, and roughly 6.8 percent will have it at some point in their lives.
Source: NIMH, National Comorbidity Survey Replication
Women are more than twice as likely as men to develop PTSD (lifetime prevalence of about 9.7 percent versus 3.6 percent).
Source: NIMH
About 7 percent of veterans will have PTSD at some point in their lives, with higher rates among those deployed to Iraq and Afghanistan.
Source: US Department of Veterans Affairs, National Center for PTSD
Trauma-focused psychotherapies such as prolonged exposure and cognitive processing therapy are recommended as first-line treatment over medication.
Source: VA/DoD Clinical Practice Guideline for PTSD (2023)
How we diagnose it at Stedfast Psychiatry
A PTSD evaluation at Stedfast Psychiatry begins with a clinical interview paced at your comfort. We use the PCL-5 (PTSD Checklist for DSM-5) to measure symptoms and track change, and the PHQ-9 and GAD-7 for the depression and anxiety that frequently accompany PTSD. We ask about the timing of the trauma and the onset of symptoms, sleep and nightmares, substance and alcohol use, chronic pain, traumatic brain injury in veterans and accident survivors, and safety at home. We distinguish PTSD from acute stress disorder (symptoms within the first month), adjustment disorder, panic disorder and depression. Labs are ordered when a medical contributor such as thyroid disease or sleep apnea is suspected.
Treatment options
Medication management
SSRIs are first-line: sertraline and paroxetine are FDA-approved for PTSD, and fluoxetine and the SNRI venlafaxine have strong evidence. We start at a low dose and increase over several weeks; sleep and irritability often improve first, with broader benefit by eight to twelve weeks. Prazosin, an alpha-1 blocker, reduces trauma nightmares and improves sleep for many patients and is titrated at bedtime while watching blood pressure. We avoid benzodiazepines in PTSD because they do not help the core symptoms and can interfere with trauma therapy. Low-dose atypical antipsychotics or mood stabilizers are occasionally added for severe agitation or when PTSD coexists with bipolar disorder. We monitor side effects, blood pressure on prazosin and venlafaxine, and suicidal thoughts at every visit.
Psychotherapy
Trauma-focused therapy is the most effective treatment for PTSD and is recommended by the VA, the Department of Defense and the American Psychological Association. Prolonged exposure (PE) helps you approach memories and situations you have been avoiding in a controlled, graduated way. Cognitive processing therapy (CPT) targets the beliefs the trauma left behind, such as self-blame or the sense that nowhere is safe. Eye movement desensitization and reprocessing (EMDR) is a third well-supported option. Each is typically 8 to 16 sessions. Our therapists coordinate with your prescriber, and many patients combine therapy with an SSRI.
Interventional options
Deep TMS is not FDA-cleared for PTSD. It is cleared for major depressive disorder, OCD, anxious depression and smoking cessation, and because depression accompanies PTSD in about half of cases, patients with treatment-resistant depression alongside PTSD may be candidates for Deep TMS at our Palm Beach Gardens office for the depressive component. Spravato (esketamine) is FDA-approved for treatment-resistant depression and MDD with suicidal ideation in adults 18 and older, not for PTSD itself; it may be appropriate when PTSD coexists with depression that has not responded to two or more antidepressants.
What to expect
Your first visit is a 45 to 60 minute evaluation with a psychiatric provider, in person or by video. You control how much detail you share about the trauma; the diagnosis does not require a full account. You leave with a plan that may include medication, a referral to one of our trauma-focused therapists, or both. Follow-ups are every two to four weeks while medication is adjusted, then every one to three months. Telehealth is available throughout Florida and South Carolina and is often preferred by patients who find waiting rooms difficult.
When to seek help
Seek help if trauma symptoms have lasted more than a month, if you are avoiding more and more of your life, if nightmares are wrecking your sleep, or if you are using alcohol or drugs to cope. Do not wait for it to pass on its own; untreated PTSD often becomes chronic. If you are having thoughts of suicide, call or text 988. Veterans can also reach the Veterans Crisis Line by dialing 988 and pressing 1. If you are in immediate danger, call 911.
Acute stress, PTSD and delayed onset
In the first month after a trauma, intense symptoms are called acute stress disorder and many people recover with support alone. PTSD is diagnosed when symptoms persist beyond one month. Some people develop full symptoms only months or years later, often after a new stressor, retirement or a reminder; this delayed expression is well documented in veterans. PTSD with dissociative symptoms, where you feel detached from your body or that the world is unreal, is a recognized subtype that benefits from a stabilization phase before exposure work.
Conditions that travel with PTSD
About half of people with PTSD also have major depression, and substance use disorders, panic disorder, chronic pain, insomnia and traumatic brain injury are common. Alcohol is often used to blunt hyperarousal and sleep, and it worsens both over time. In veterans, mild TBI and PTSD overlap heavily and need to be sorted out because headaches, memory problems and irritability can come from either. We treat these together rather than one at a time, and we screen for them at every evaluation.
Military and first-responder trauma
Combat exposure, military sexual trauma, and the cumulative occupational trauma of police, firefighters, paramedics and emergency nurses produce PTSD with some distinct features: moral injury (guilt over actions taken or not taken), survivor guilt, a strong culture of not seeking help, and overlap with traumatic brain injury and chronic pain. Treatment is the same evidence-based therapy and medication, delivered by clinicians who understand the context. We accept TRICARE at many offices, coordinate with VA community care, and provide documentation for disability claims when asked.
Supporting recovery outside the office
Regular sleep, exercise and reduced alcohol all lower the baseline arousal that drives PTSD symptoms. Staying connected to at least a few trusted people counters the pull toward isolation. Grounding techniques (naming five things you can see, feeling your feet on the floor, slow exhale breathing) help during flashbacks and are taught early in therapy. Avoiding avoidance matters: each time you approach a reminder and nothing bad happens, the alarm quiets slightly. Peer support through veteran organizations and survivor groups adds a layer that clinicians cannot provide.
Prognosis
PTSD responds well to treatment. In clinical trials of prolonged exposure and cognitive processing therapy, roughly half to two thirds of patients no longer meet criteria for PTSD at the end of treatment, and gains hold at follow-up. Medication produces more modest but meaningful improvement. Without treatment, about one third of cases become chronic, with ongoing effects on health, work and relationships. The single best predictor of a good outcome is starting evidence-based treatment and finishing the course.
Frequently asked questions
Do I have to talk about the trauma to get treated?
Not at the first visit, and not in detail unless and until you choose to. A diagnosis can be made from your current symptoms and a brief description of the type of event. Medication does not require revisiting the trauma at all. Trauma-focused therapies such as PE and CPT do involve working with the memory, but at a pace you control, and they are the most effective treatments available because they resolve the memory rather than managing around it.
What is the best medication for PTSD?
Sertraline and paroxetine are FDA-approved for PTSD, and fluoxetine and venlafaxine are also well supported. They reduce intrusive symptoms, irritability and depression over 8 to 12 weeks. Prazosin is the best-studied medication for trauma nightmares. No medication is as effective as trauma-focused therapy, and combining the two is common. Benzodiazepines are not recommended for PTSD.
How long does PTSD treatment take?
Trauma-focused therapy is usually 8 to 16 weekly sessions, and many people see large improvements within that window. Medication is typically continued for at least 12 months after improvement. Complex trauma from childhood or repeated events may take longer. PTSD rarely resolves fully on its own after it has lasted more than a year, so starting treatment is the main variable you control.
Can PTSD be treated by telehealth?
Yes. Both medication management and trauma-focused therapy, including prolonged exposure and cognitive processing therapy, have been delivered by video in VA and civilian studies with results comparable to in-person care. We treat patients across Florida and South Carolina by telehealth, which also removes the barrier of a crowded waiting room for people who are easily triggered. Many patients start in person and move to video, or combine both depending on the week.
Do you treat veterans and first responders?
Yes. Several of our offices, including Jacksonville, Goose Creek and Melbourne, serve large military communities, and our providers treat combat trauma, military sexual trauma and occupational trauma in police, fire and EMS. We accept TRICARE at many locations and can coordinate with VA care through community care referrals. We also treat family members affected by a loved one's PTSD.
Is PTSD treatment covered by insurance?
Yes. We accept most major insurance plans, Medicare and TRICARE at many offices, and visits are billed as specialist mental health visits with your usual copay. Our self-pay rate for a new evaluation is $185. Sertraline, paroxetine and prazosin are inexpensive generics. Trauma-focused therapy is covered under outpatient mental health benefits, and we can also coordinate VA community care authorizations for eligible veterans who prefer to be seen locally.
What is complex PTSD?
Complex PTSD describes the effects of prolonged or repeated trauma, often beginning in childhood, that add problems with emotion regulation, self-worth and relationships to the core PTSD symptoms. It is recognized in the WHO classification (ICD-11) and overlaps with what DSM-5-TR calls PTSD with associated features. Treatment uses the same trauma-focused therapies, often with a longer stabilization phase and skills work first.
Can children develop PTSD?
Yes. Children can develop PTSD after abuse, accidents, medical trauma, violence at home or in the community, and disasters. Symptoms may look like regression, nightmares, clinginess, reenacting the event in play, or new behavioral problems. Trauma-focused CBT (TF-CBT) is the first-line treatment for children and teens, and our child and adolescent providers involve caregivers throughout.
Where to get treatment for post-traumatic stress disorder
Evaluation and treatment for post-traumatic stress disorder is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.