People who have suffered major traumatic events may develop a syndrome known as post-traumatic stress disorder. This condition is characterised by intrusive, distressing re-experiencing of the event in thoughts and dreams. These anxiety symptoms are liable to pose considerable restrictions on one's lifestyle, and must therefore be taken seriously. Although spontaneous recovery may occur after only a few months, in some patients the disorder may become chronic.
A commentary in the Lancet for October 23 makes the point that, unlike chronic stress and depressive states, post-traumatic depression is accompanied by decreased circulating cortisol concentrations, increased sensitivity of the glucocorticoid receptor, and negative feedback to low doses of dexamethasone. As regards treatment of the condition, psychological therapies are in general more effective than pharmacological treatment. The most effective are behaviour therapy and eye-movement desensitisation and reprocessing. Drug treatment is, however, easier to administer and less demanding on the patient, but requires further assessment. The two types of treatment may be applied in conjunction.
Antidepressant drugs offer the most promising pharmacological approach. Fluoxetine has proved effective. Generally, the first-line treatment agents are the selective serotonin-reuptake inhibitors. In second place come tricyclic antidepressants or monoamine oxidase inhibitors. Experts have advocated the use of nefazodone, a serotonin receptor blocker, or venlafaxine, which blocks uptake of serotonin and noradrenaline.
Benzodiazepines are not recommended, since they carry a distinct risk of inducing dependence, and patients offer considerable resistance to allowing them to be withdrawn.