PTSD doesn’t only affect combat veterans. It affects survivors of car accidents, assault, medical trauma, sudden bereavement, witnessing violence, and prolonged childhood adversity. And it doesn’t always resolve on its own — even decades after the event.
According to the U.S. Department of Veterans Affairs National Center for PTSD, about 6% of U.S. adults will have PTSD at some point in their lives. Women have approximately twice the lifetime risk of men. And most of them — about two-thirds — have not received adequate treatment.
What PTSD Actually Is
Post-traumatic stress disorder is diagnosed when exposure to actual or threatened death, serious injury, or sexual violence produces a specific cluster of symptoms lasting more than one month and causing significant distress or impairment. The four symptom clusters are:
Intrusion symptoms
Involuntary, intrusive memories of the trauma; recurrent distressing dreams; flashbacks where the person feels or acts as if the event were recurring; intense psychological distress at reminders; physical reactivity to reminders.
Avoidance
Efforts to avoid distressing memories, thoughts, feelings, or external reminders (people, places, situations) associated with the trauma.
Negative alterations in cognition and mood
Difficulty remembering parts of the trauma; persistent negative beliefs about self, others, or the world; distorted blame about the cause or consequences; persistent negative emotional state; markedly diminished interest in activities; feeling detached from others; inability to experience positive emotions.
Alterations in arousal and reactivity
Irritability, angry outbursts; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; concentration problems; sleep disturbance.
PTSD vs Complex PTSD
Standard PTSD often results from a single traumatic event. Complex PTSD (C-PTSD), now formally recognized in the ICD-11, results from prolonged, repeated trauma — typically interpersonal trauma like childhood abuse, domestic violence, or human trafficking. C-PTSD includes all the standard PTSD symptoms plus three additional domains:
- Severe difficulties with emotion regulation
- Persistent negative self-concept — feeling worthless, defeated, or fundamentally damaged
- Significant difficulties in relationships and sustained social connection
Recognizing C-PTSD matters because the treatment approach differs — longer treatment courses, more emphasis on stabilization before trauma-focused work, often higher rates of comorbid conditions.
The Neurobiology of PTSD
PTSD involves measurable changes in three brain regions: the amygdala (hyperactive — driving the threat response), the prefrontal cortex (underactive — failing to dampen the amygdala), and the hippocampus (often reduced in volume — affecting memory contextualization). The HPA axis is dysregulated, and the autonomic nervous system is chronically activated.
These aren’t theoretical findings — they’re documented on neuroimaging and they explain why PTSD symptoms persist even when the danger is long past. The brain hasn’t “moved on” because the underlying biology hasn’t normalized.
Source: VA/DoD Clinical Practice Guidelines for PTSD.
Evidence-Based PTSD Treatment
First-line medications
SSRIs — particularly sertraline and paroxetine — have FDA approval for PTSD and are first-line. Venlafaxine (SNRI) is also evidence-based. Prazosin is highly effective for trauma-related nightmares specifically. Mood stabilizers may help with reactivity in certain patients.
Trauma-focused psychotherapy
Prolonged exposure therapy, cognitive processing therapy, and EMDR all have strong evidence for PTSD. Most patients benefit from combining medication with trauma-focused therapy. Dr. Farkas regularly coordinates with trauma-specialist therapists for combined treatment.
Adjunctive approaches
For severe or refractory PTSD, additional options include MDMA-assisted therapy (in active clinical trials, with FDA review ongoing), ketamine, and TMS. None of these are first-line, but they’re appropriate when standard treatment has failed.
“Just move on”
PTSD patients are often told their trauma “happened a long time ago” — as if neurobiological changes resolve on a calendar.
Treat the biology
Dr. Farkas addresses PTSD as a medical condition with biological underpinnings — using evidence-based medication and coordinating with trauma-specialist therapists.
Recovery is possible
Most PTSD patients achieve significant improvement with proper combined treatment — even when symptoms have persisted for years.
Why Telepsychiatry Works Well for PTSD
For many PTSD patients, the prospect of an office visit itself is anxiety-provoking — particularly for those with hypervigilance, agoraphobia, or trauma history involving medical settings. Telepsychiatry from a familiar, controlled environment removes that barrier. Research from the VA, which has been a major adopter of telepsychiatry for PTSD, consistently shows equivalent outcomes to in-person care with higher patient retention.
Common Questions About PTSD
Can PTSD develop years after the trauma?
Yes. Delayed-onset PTSD is real — symptoms can emerge months or years after the event, sometimes triggered by a related stressor, life transition, or anniversary. The biological vulnerability persists; the symptoms can surface later.
Do I have to talk about my trauma in detail to be treated?
Not necessarily. While trauma-focused therapy involves processing the memories, medication management with Dr. Farkas doesn’t require detailed trauma disclosure. The medication addresses the biological symptoms — and you can do that work at your own pace.
Will SSRIs make me forget what happened?
No — SSRIs don’t erase memory. They reduce the intensity of the emotional and physical response to trauma reminders, making the memories less acutely distressing. The history is still there; it just stops dominating your present.
What if I have PTSD plus depression or anxiety?
PTSD frequently coexists with depression and anxiety — sometimes simultaneously. Treatment targets the whole picture, not just one diagnosis. See our related articles on anxiety disorders and major depression.