PTSD Medication vs. Trauma Therapy: What the Guidance Says

What the guidance actually says

NIMH describes the main treatments for PTSD as psychotherapy, medications, or a combination of both, and says an experienced mental health professional can help find the plan that fits your symptoms and needs. It does not rank them on that page.

The VA/DoD guideline goes further, and this ranking belongs to the guideline. It recommends individual psychotherapies listed in its Recommendation 8 over pharmacologic interventions (Strong for). Those three therapies are Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure. The panel rated its confidence in this evidence as moderate, and noted a small number of direct comparison studies with small sample sizes.

It also says "both psychotherapy and pharmacotherapy are effective in treating PTSD," and recommends paroxetine, sertraline or venlafaxine (Strong for). The panel reports one recent trial that directly compared Prolonged Exposure, sertraline and the combination, and that found no difference among the groups over 24 weeks.

Side by side

• What happens: therapy means meeting with a therapist to work on the trauma or its meaning. Medicine means taking it as prescribed, with regular check-ins.
• Talking about the trauma: the National Center for PTSD says you will not need to discuss the details for medication, though a provider may ask basic questions. Trauma-focused therapies work with the memory or its meaning in different ways.
• Time: the National Center for PTSD says most of these therapies last about 3 months. It says medicines can take a few weeks to notice, and you will need to keep taking them for the benefit to continue.
• After treatment: the guideline says the positive effects of medication are lost when medications are stopped, and that trauma-focused therapy improvements appear to last for longer periods.
• Side effects: the guideline says negative side effects or reactions, which vary by person, are generally more likely with medicine than with therapy.
• Practical demands: the guideline notes that therapy is more resource intensive because of frequent appointments. Time and access can be real barriers.

Why people choose one or the other

The guideline says patient preferences vary widely. Some people strongly prefer one approach, and most patients in the studies it reviewed appear to prefer psychotherapy. It also notes the limits of that research.

Medication may fit when therapy is not available or feasible, or when you prefer it. The National Center for PTSD gives simple examples for thinking about fit: if you are comfortable talking about your trauma with a therapist, trauma-focused therapy could be a good match. If you know you would forget to take medicine regularly, medicine may not be the right fit.

Its Choosing a Treatment page lists useful questions: what is available to you, whether you can work well with the clinician, which treatments meet your goals, and whether other health conditions need attention too. There is no scientific way to know in advance which treatment will work best for one person.

What about using both

NIMH notes that providers may prescribe SSRIs and other medications along with psychotherapy. The guideline says there is insufficient evidence to recommend for or against combining recommended therapies or medicines with other treatment. So using both is an option some people choose, without a guideline statement that it works better or worse than using one.

If you are curious about what that looks like in practice, our guide on taking medication during EMDR or trauma therapy covers telling both clinicians and coordinating care.

Where to find each one with us

Medicine: a licensed psychiatrist on our team treats trauma by secure video for people physically located in Pennsylvania or New York during each visit. See medication management and read about sertraline, paroxetine and venlafaxine. Whether a medicine is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help through our medication care contact form.

Therapy: trauma therapy with our team is available in Pennsylvania, West Virginia, Arizona and Colorado, and our therapists do not prescribe. New York readers can see our psychiatrist but not a therapist here. Our trauma and PTSD therapy page lists where it is offered, and online trauma treatment brings the options together. Members of the team use approaches including EMDR, so ask which one a therapist uses.

If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Whichever path you are weighing, NIMH's message is hopeful: you can get better with treatment.