Online Trauma and PTSD Treatment in Pennsylvania and New York

What treatment for PTSD involves

After a traumatic event, most people recover from early reactions over time. The National Institute of Mental Health (NIMH) says people whose symptoms continue may be diagnosed with post-traumatic stress disorder (PTSD), and that you can get better with treatment. The main treatments are psychotherapy, medication, or a combination.

You do not have to describe what happened in detail to learn your options. This page explains the talk therapies and the medicine groups in the 2023 VA/DoD Clinical Practice Guideline, written by the U.S. Departments of Veterans Affairs and Defense. In its wording, "we recommend" is a strong recommendation and "we suggest" is a weak one.

The guideline's first treatment-selection statement is: "We recommend individual psychotherapies, listed in Recommendation 8, over pharmacologic interventions for the treatment of PTSD." That is rated Strong for. The National Center for PTSD adds that medication is an effective option when those therapies are not available or feasible, or when a person prefers medication.

Therapy approaches, and what each one is

"Trauma-focused" means the therapy centers on the memory of the event and what it means to you. The guideline sorts talk therapies by the strength of its recommendation:

• Recommended (Strong for): Cognitive Processing Therapy, which works on upsetting thoughts and feelings since the trauma; Prolonged Exposure, which gradually approaches memories, feelings and situations you have been avoiding; and Eye Movement Desensitization and Reprocessing (EMDR), which processes the memory while you attend to a back-and-forth movement or sound.
• Suggested (Weak for): Ehlers' Cognitive Therapy for PTSD, Present-Centered Therapy, which focuses on current problems rather than the trauma, and Written Exposure Therapy, which uses writing during sessions.
• Insufficient evidence to recommend for or against: a longer list that includes Accelerated Resolution Therapy (ART) and Dialectical Behavior Therapy.

Medicine groups, and where each stands

Only sertraline and paroxetine are FDA-approved for PTSD, and every other use for PTSD is off-label. A guideline recommendation and an FDA approval are separate things, so both are shown here.

• SSRIs (antidepressants that act on serotonin): sertraline and paroxetine are FDA-approved for PTSD and recommended (Strong for). The guideline finds insufficient evidence to recommend for or against citalopram, escitalopram and fluoxetine.
• SNRIs (antidepressants that act on serotonin and norepinephrine): venlafaxine is off-label for PTSD and recommended (Strong for). Evidence is insufficient to recommend for or against desvenlafaxine and duloxetine.
• Alpha-blocker: prazosin is an off-label blood pressure medicine. The guideline suggests it for nightmares associated with PTSD (Weak for) and suggests against it for PTSD overall (Weak against).
• Benzodiazepines: the guideline recommends against them for PTSD (Strong against). If you take one, keep working with your prescriber and do not stop suddenly.
• Antipsychotics: the guideline suggests against adding any of a listed group to medications for PTSD (Weak against), and suggests against risperidone for PTSD. Evidence is insufficient to recommend for or against olanzapine or quetiapine for PTSD.
• Mood stabilizers: it suggests against divalproex and tiagabine (Weak against), and finds insufficient evidence to recommend for or against lamotrigine or topiramate.

Risks to know about medicine

The labels for sertraline and paroxetine carry a boxed warning, the FDA's most prominent kind: antidepressants increased the risk of suicidal thoughts and behaviors in children, teens and young adults, and everyone taking them should be watched closely for worsening. Those labels also say not to combine them with MAOIs, a group of medicines, and to reduce the dose gradually rather than stopping abruptly whenever possible.

If you are in crisis or thinking of harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. No medicine here is a recommendation for you. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help.

Who you can see here, and where

Medication care: a licensed psychiatrist on our team, a Doctor of Osteopathic Medicine with more than three decades of practice, treats anxiety, depression and trauma by secure video. You must be physically located in Pennsylvania or New York during each visit. Read more about medication management. Our therapists do not prescribe.

Therapy: trauma therapy with our team is for clients physically located in Pennsylvania, West Virginia, Arizona or Colorado. New York readers can see our psychiatrist here, but not a therapist here. Services differ by state, so check our trauma and PTSD therapy page or ask what is available where you live. Members of the team use approaches including EMDR, ART and trauma-focused CBT. Not every therapist uses every approach, so ask which one yours uses.

Getting started

1. 1Reach outSend us a note through our medication care contact form or call 267-573-9817, and tell us which state you will be in during visits.
2. 2Ask your practical questionsAsk us about fees, insurance for psychiatry, ages seen and timing, and whether therapy here is required.
3. 3Meet by videoFrom a private spot, talk through your history and goals. You choose how much to share, and a visit may or may not lead to a prescription.