Understanding PTSD

Post-traumatic stress disorder (PTSD) develops when someone has experienced or witnessed a traumatic event and develops lasting symptoms of fear, anxiety, and emotional dysregulation. Approximately 6% of the U.S. population experiences PTSD at some point in their lives, yet it remains deeply misunderstood. PTSD is not a sign of weakness or an inability to “move on” – it’s a recognized psychiatric condition that involves measurable changes in brain chemistry and structure. With proper treatment, recovery is absolutely possible.

At MindMED Behavioral Health, we view PTSD as a treatable medical condition, not a character flaw. Trauma is a human experience, and so is healing. What matters is that you receive compassionate, competent care from someone who understands both the neurobiology of trauma and the emotional weight of what you’ve endured.

PTSD can develop after exposure to various types of trauma: combat and military service, sexual or physical assault, serious accidents, life-threatening medical events, childhood abuse or neglect, natural disasters, or witnessing violence or death. Importantly, not everyone who experiences trauma develops PTSD – resilience factors, prior mental health history, access to support, and individual neurobiological differences all influence whether PTSD develops. This means your traumatic experience doesn’t automatically predict your diagnosis or prognosis.

Types of Trauma-Related Conditions

While PTSD is the most well-known trauma-related diagnosis, Dr. Fredes evaluates for the full spectrum of trauma-related conditions:

• Post-Traumatic Stress Disorder (PTSD) – Develops after exposure to a traumatic event with symptoms lasting longer than one month. Involves re-experiencing, avoidance, negative mood/cognition changes, and hyperarousal lasting months to years.
• Complex PTSD (C-PTSD) – Develops after prolonged or repeated trauma (often interpersonal, such as childhood abuse, intimate partner violence, or human trafficking). Includes PTSD symptoms plus difficulty regulating emotions, negative self-perception, and relationship problems.
• Acute Stress Disorder – Occurs within 3 days to one month after trauma exposure. Similar symptoms to PTSD but shorter duration. Early intervention can prevent progression to full PTSD.
• Adjustment Disorder with Anxiety or Depressed Mood – Develops in response to an identifiable stressor (though not necessarily what we’d call “trauma”). Symptoms are present within three months of the stressor and cause meaningful distress or dysfunction.

Recognizing PTSD Symptoms

PTSD symptoms cluster into four primary categories. Understanding these helps you recognize whether what you’re experiencing warrants professional evaluation.

Re-experiencing symptoms: Intrusive memories or flashbacks of the trauma, distressing nightmares, severe emotional reactions to reminders of the event, and physical reactions (racing heart, panic) when exposed to trauma-related triggers. Some people experience “dissociative flashbacks” where they feel like they’re reliving the event rather than remembering it.

Avoidance: Avoiding thoughts, conversations, or feelings related to the trauma; avoiding people, places, or activities that trigger memories; emotional numbing or detachment from loved ones; reduced interest in activities previously enjoyed. Avoidance often develops as a protective mechanism but can reinforce PTSD over time.

Negative changes in thinking and mood: Persistent negative beliefs about oneself (“I’m broken,” “I’m dangerous”), the world (“people can’t be trusted,” “the world is unsafe”), or others; guilt or shame (often called “shame of the survivor”); memory gaps about the traumatic event; difficulty concentrating; decreased interest in relationships or activities; feelings of detachment or emotional flatness; persistent anger or irritability.

Hyperarousal (heightened reactivity): Hypervigilance (constantly scanning the environment for danger), exaggerated startle response, self-destructive or reckless behavior, difficulty concentrating, sleep disturbance (nightmares, insomnia, or sleeping excessively), irritability or aggressive behavior. This reflects a nervous system stuck in “high alert” mode even when there’s no immediate danger.

It’s crucial to understand that normal grief, stress, or sadness after trauma is not PTSD. The difference lies in duration (PTSD symptoms persist for more than one month), intensity (symptoms are significantly distressing), and functional impact (they substantially interfere with work, relationships, or self-care). A trained psychiatrist can distinguish PTSD from normal trauma response and other conditions that may look similar.

The Importance of Professional Treatment

Many people believe they should “just get over it” or that time alone will heal trauma. While time does help, untreated PTSD often becomes chronic. Research shows that PTSD without treatment tends to persist or worsen over time, with approximately 50% of people with untreated PTSD still having significant symptoms years or decades later. The good news is that professional treatment dramatically improves these odds.

PTSD creates measurable changes in brain function – the amygdala (fear center) becomes hyperactive, the prefrontal cortex (rational thinking center) becomes underactive, and the stress hormone system becomes dysregulated. These aren’t character flaws; they’re predictable neurobiological responses to trauma. Medication and therapy work by helping restore balance to these systems. Without intervention, people with untreated PTSD face increased risks of depression, substance use disorders (which often develop as self-medication), chronic pain, relationship breakdown, occupational disability, and suicide. These aren’t inevitable outcomes, but they illustrate why professional treatment matters.

Dr. Fredes takes a trauma-informed approach to your care. This means understanding that trauma affects how you process safety, trust, and control – and designing treatment accordingly. You set the pace. You decide what you’re ready to discuss. Your autonomy and dignity are central to healing.

Our Treatment Approach

Dr. Fredes provides comprehensive psychiatric evaluation and management tailored to your individual presentation and needs. This integrative approach combines medication management with attention to sleep, lifestyle, and coordination with your therapist if you have one.

Medications for PTSD

Medication is often a cornerstone of PTSD treatment, particularly when combined with therapy. Several medications have strong evidence for PTSD, and Dr. Fredes selects based on your symptom profile, medical history, and goals.

SSRIs (first-line): Sertraline (Zoloft) and paroxetine (Paxil) are the only two medications FDA-approved specifically for PTSD. Both have robust research supporting their efficacy for PTSD’s core symptoms – intrusive memories, avoidance, and hyperarousal. Other SSRIs like fluoxetine are also commonly used off-label. SSRIs typically take 4–8 weeks to show meaningful benefit; full effect may take 8–12 weeks. They’re safe with few serious drug interactions and can be used long-term.

SNRIs: Venlafaxine (Effexor XR) works by affecting both serotonin and norepinephrine, making it effective for PTSD, particularly when hyperarousal and anxiety are prominent. Research supports its efficacy at therapeutic doses (typically 150–225mg daily).

Prazosin: An alpha-blocker originally used for high blood pressure, prazosin has strong evidence for reducing trauma-related nightmares and sleep disturbance. It works better for nightmare suppression than for other PTSD symptoms but can dramatically improve sleep quality and daytime functioning.

Sleep medications: When insomnia is severe, short-term sleep medications like trazodone or doxepin may help establish sleep, but they’re used strategically – the goal is restoring natural sleep, not dependence. Prazosin, sleep hygiene, and addressing trauma memories with your therapist are longer-term solutions.

What doesn’t work well for PTSD: Benzodiazepines (Xanax, Klonopin, Valium), while sometimes used short-term for acute anxiety, are generally not recommended as ongoing PTSD treatment because they don’t address core symptoms, carry addiction risk, and may actually interfere with fear extinction that happens in trauma therapy. We use them cautiously and for limited periods if at all.

Dr. Fredes works collaboratively with you on medication – discussing options, monitoring side effects, and adjusting based on response. Starting low and going slow is standard; rushing to higher doses doesn’t improve outcomes and increases side effects.

PTSD and Co-Occurring Conditions

PTSD rarely exists in isolation. Depression, anxiety disorders, substance use, chronic pain, and sleep disorders commonly co-occur. Understanding these connections is essential for effective treatment.

Depression: Approximately 50–80% of people with PTSD develop depression at some point. The negative thinking and emotional numbing of PTSD overlap with depression, making the picture complex. Both conditions respond to many of the same medications (SSRIs/SNRIs) and therapies, but recognizing depression as separate allows us to address both adequately.

Substance use disorders: PTSD more than doubles the risk of developing substance use problems. Some people initially turn to alcohol or drugs to self-medicate trauma symptoms – suppressing nightmares, numbing emotional pain, or quieting intrusive thoughts. Over time, substance use creates additional problems, interferes with PTSD treatment, and can create its own psychiatric condition. We address both simultaneously through careful medication management, supporting therapy, and when needed, addiction specialist coordination.

Other anxiety disorders: Generalized anxiety, panic disorder, or social anxiety often co-occur with PTSD. The distinction matters clinically because treatment approaches may differ slightly.

Chronic pain: Many trauma survivors experience chronic pain – sometimes tied to physical injury, sometimes reflecting the way trauma gets stored in the body. Pain and PTSD amplify each other, and treatment must address both.

Traumatic brain injury (TBI): When trauma involves head injury (combat, motor vehicle accidents, assaults), TBI and PTSD co-occur. TBI can mimic or exacerbate PTSD symptoms, complicating diagnosis. Comprehensive evaluation matters.

The reason we screen comprehensively for co-occurring conditions is simple: missing depression or untreated substance use can derail your entire treatment plan. When we address the full picture, outcomes improve dramatically.

What to Expect in Treatment

Your first appointment: Initial psychiatric evaluation for PTSD is thorough (60–90 minutes). Dr. Fredes will ask about your trauma history, current symptoms, medical history, medications, substance use, previous mental health treatment, and how PTSD is affecting your daily life. This isn’t about forcing you to recount trauma in graphic detail – it’s about understanding your experience enough to make good clinical decisions. You control the pace and level of detail you share.

Building the relationship: Healing from trauma requires trust. Dr. Fredes approaches this knowing that many trauma survivors have learned not to trust – and that’s a rational response to what happened. Trust is built through consistency, follow-through, respect for your autonomy, and demonstrated competence. This doesn’t happen overnight, and that’s okay.

Pacing of treatment: There’s no rush to dive into traumatic memories. Many people benefit from stabilization first – getting sleep better, anxiety more manageable, and foundational trust established – before engaging with deeper trauma processing. Your therapist and psychiatrist coordinate around this pace.

Healing is not linear: Some weeks you’ll feel significantly better. Some weeks will be harder. This doesn’t mean treatment isn’t working – it reflects the reality of how healing progresses. We track trends over months, not daily fluctuations.

When to seek crisis help: If you experience suicidal thoughts, severe panic, or feel you might harm yourself, please contact emergency services (911), a crisis line (988 in the U.S.), or go to your nearest emergency room. These situations warrant immediate evaluation, not a wait until your next appointment.

Frequently Asked Questions About PTSD

How do I know if I have PTSD? PTSD involves specific symptoms that develop after trauma exposure: intrusive memories or flashbacks, nightmares, avoidance of triggers, emotional numbing, persistent negative thoughts or mood changes, hypervigilance, startle responses, and sleep problems. These symptoms persist for more than one month after trauma and significantly interfere with daily functioning. Not everyone who experiences trauma develops PTSD. A thorough psychiatric evaluation can distinguish PTSD from normal grief or stress responses.

Can PTSD develop years after a traumatic event? Yes. While PTSD typically develops within three months of a traumatic event, delayed-onset PTSD can appear months or even years later. This is sometimes triggered by a reminder of the original trauma, a new stressor, or significant life changes. If you notice trauma-related symptoms appearing long after an event, professional evaluation is important.

Is PTSD only for military veterans? No. PTSD can develop after any significant trauma – combat exposure, physical or sexual assault, serious accidents, medical trauma, childhood abuse, natural disasters, witnessing violence, or other frightening events. Approximately 6% of the U.S. population experiences PTSD at some point. Dr. Fredes works with individuals from all backgrounds who have experienced trauma.

Will I need medication for PTSD? Medication is often helpful for PTSD, especially when combined with therapy. SSRIs like sertraline and paroxetine are FDA-approved specifically for PTSD and address core symptoms. Other medications such as SNRIs or prazosin (for nightmares) may also be appropriate based on your symptoms and medical history. Dr. Fredes works collaboratively with you to determine the best treatment plan for your specific situation.

How long does PTSD treatment take? Treatment timelines vary. Many people experience meaningful improvement within 8–12 weeks as medication begins working. However, healing from trauma is not linear – some weeks you progress, some weeks feel stalled. Most people benefit from ongoing psychiatric care for several months to years. Your specific timeline depends on trauma severity, co-occurring conditions, therapy engagement, and individual factors. We’ll monitor progress together and adjust treatment as needed.

Can PTSD be cured? PTSD can be effectively treated and symptoms can resolve substantially. With evidence-based medication management and therapy, many people achieve a state where trauma no longer controls their daily life. Some people find that while they remember the traumatic event, the emotional charge and intrusive symptoms diminish significantly. Recovery is possible, even if the path isn’t always straightforward.

What if I can’t talk about my trauma? That’s completely understandable. Many trauma survivors aren’t ready to discuss details of what happened. Dr. Fredes takes a trauma-informed approach that respects your pace and boundaries. Treatment can begin with medication management and stabilization before diving into detailed trauma processing. Your therapist and psychiatrist can work together to develop a plan that feels safe and appropriate.

Do you work with trauma therapists? Yes. Dr. Fredes coordinates regularly with evidence-based trauma therapists in the Southlake and DFW areas who specialize in therapies like Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR). We believe optimal outcomes come from collaboration between your psychiatrist and therapist. If you don’t have a trauma therapist, we can recommend excellent providers.

Insurance & Pricing

We accept major insurance plans to make quality psychiatric care accessible:

For patients without insurance coverage, we offer self-pay options with transparent pricing. We also provide superbills for out-of-network reimbursement. View full pricing details →

Why Choose MindMED for PTSD Treatment?

• Board-certified psychiatrist with trauma-informed training – Dr. Fredes brings both psychiatric expertise and specialized understanding of how trauma affects the brain and nervous system
• Dr. Fredes sees every patient herself – You work directly with a board-certified psychiatrist from day one, not a mid-level provider. This continuity and accountability matter in trauma care
• Unhurried appointments – Your initial evaluation is 60–90 minutes, giving Dr. Fredes time to understand your full picture without rush
• Integrated coordination – We work closely with trauma therapists you may be seeing, ensuring your medication management and therapy are aligned
• Individualizing treatment – No one-size-fits-all approach. We tailor medication choices, treatment pace, and care coordination to your specific needs and readiness
• Bilingual care – Services available in English and Spanish
• In-person and telehealth – Flexible options for patients across Texas, New York, and Virginia
• Insurance accepted – Aetna, BCBSTX, Cigna, Oscar, and United Healthcare