What we treat
Compassionate, evidence-based psychiatric care for post-traumatic stress disorder and trauma-related conditions
Post-traumatic stress disorder (PTSD) develops after someone experiences or witnesses a traumatic event and is left with lasting symptoms of fear, anxiety, and emotional dysregulation. About 6% of people in the U.S. experience PTSD at some point in their lives. It is a recognized psychiatric condition with measurable effects on the brain, and it responds to treatment.
PTSD can follow many kinds 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. Not everyone who goes through trauma develops PTSD. Prior mental health history, support, and individual differences all play a part, so what happened to you does not by itself predict your diagnosis or your outlook.
Dr. Fredes evaluates for the full range of trauma-related conditions:
PTSD symptoms fall into four groups. Re-experiencing: intrusive memories, flashbacks, nightmares, and strong emotional or physical reactions to reminders. Avoidance: steering clear of people, places, conversations, or feelings connected to the trauma, and emotional numbing. Negative changes in thinking and mood: persistent beliefs that you are broken or that the world is unsafe, guilt or shame, memory gaps, loss of interest, and feeling detached. Hyperarousal: hypervigilance, an exaggerated startle response, irritability, trouble concentrating, reckless behavior, and disrupted sleep.
Grief, stress, and sadness after a trauma are normal and are not PTSD. The difference is duration (symptoms lasting more than a month), intensity, and how much they interfere with work, relationships, or self-care. A psychiatric evaluation can tell these apart.
Untreated PTSD tends to persist, and depression, substance use, and relationship strain often follow. Dr. Fredes provides psychiatric evaluation and medication management, with attention to sleep and coordination with your therapist if you have one. Trauma affects how you experience safety, trust, and control, so you set the pace and decide what you are ready to discuss.
Medication is often a central part of PTSD treatment, especially alongside therapy. Dr. Fredes chooses based on your symptoms, medical history, and goals.
SSRIs (first-line): Sertraline and paroxetine are the two medications FDA-approved for PTSD, with good evidence for the core symptoms of intrusion, avoidance, and hyperarousal. Other SSRIs, such as fluoxetine, are also used. Benefit usually starts within 4–8 weeks, with full effect by 8–12 weeks. They have few serious drug interactions and can be used long-term.
SNRIs: Venlafaxine acts on both serotonin and norepinephrine and is a reasonable option, particularly when anxiety and hyperarousal are prominent.
Prazosin: Originally a blood pressure medication, prazosin has good evidence for reducing trauma-related nightmares and can improve sleep considerably.
Sleep medications: When insomnia is severe, short-term options such as trazodone or low-dose doxepin can help re-establish sleep. The goal is restoring natural sleep, so these are used with a plan for stepping down.
Benzodiazepines: Not recommended as ongoing PTSD treatment. They do not address core symptoms, carry a risk of dependence, and can interfere with the fear-extinction work done in trauma therapy. If used at all, it is briefly and for a specific purpose.
Dr. Fredes starts low and increases slowly. Rushing to higher doses adds side effects without improving results.
PTSD rarely travels alone. Depression is common and overlaps with the numbing and negative thinking of PTSD; both respond to many of the same medications, but naming both lets us treat both. Alcohol or drug use often begins as a way to quiet nightmares or intrusive thoughts and then becomes its own problem. We address it alongside PTSD and coordinate with addiction specialists when needed.
Other anxiety disorders (generalized anxiety, panic, social anxiety), chronic pain, and insomnia frequently co-occur as well, and a head injury from the same event can mimic or worsen PTSD symptoms. The evaluation screens for all of these, because a missed condition can stall the whole plan.
Your first appointment: The initial evaluation is 60 minutes. Dr. Fredes asks about your trauma history, current symptoms, medical history, medications, substance use, past treatment, and how PTSD affects your daily life. You will not be asked to recount the trauma in graphic detail. You control the pace and how much you share.
Trust: Many trauma survivors have good reasons not to trust easily. Dr. Fredes does not expect that to change overnight. Trust builds through consistency, follow-through, and respect for your decisions.
Pacing: Many people do better stabilizing first (better sleep, more manageable anxiety, a working relationship with the doctor) before deeper trauma processing with a therapist. Progress is uneven. Some weeks are harder than others, and that does not mean treatment is failing. We look at trends over months.
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.
PTSD involves specific symptoms after a trauma: intrusive memories or flashbacks, nightmares, avoidance of reminders, emotional numbing, persistent negative thoughts or mood, hypervigilance, an exaggerated startle response, and sleep problems. They last more than a month and interfere with daily life. Not everyone who goes through trauma develops PTSD, and a psychiatric evaluation can separate PTSD from normal grief or stress.
Yes. PTSD usually begins within three months of the event, but delayed-onset PTSD can appear months or years later, often set off by a reminder, a new stressor, or a major life change. If trauma-related symptoms show up long after an event, an evaluation is worthwhile.
No. PTSD can follow any significant trauma: combat, physical or sexual assault, serious accidents, medical trauma, childhood abuse, natural disasters, or witnessing violence. About 6% of people in the U.S. experience PTSD at some point. Dr. Fredes works with people from all backgrounds.
Often it helps, especially combined with therapy. Sertraline and paroxetine are FDA-approved for PTSD. SNRIs or prazosin (for nightmares) may fit better depending on your symptoms and history. Dr. Fredes works through the options with you.
It varies. Many people notice meaningful improvement within 8–12 weeks of starting medication, and most benefit from ongoing psychiatric care for months to years depending on the severity of the trauma, co-occurring conditions, and therapy. Progress is uneven, so we track it over time and adjust.
PTSD can be treated effectively, and symptoms can shrink substantially. With medication and therapy, many people reach a point where the trauma no longer controls daily life: the memory remains, but the emotional charge and the intrusive symptoms fade.
That is common, and you do not have to. Dr. Fredes respects your pace and boundaries. Treatment can begin with medication and stabilization before any detailed trauma processing, and your therapist and psychiatrist can coordinate a plan that feels safe.
Yes. Dr. Fredes coordinates with trauma therapists in the Southlake and DFW areas who provide Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and EMDR. Medication and therapy tend to work best together. If you do not have a trauma therapist, we can recommend one.
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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 →
Schedule a consultation with Dr. Fredes to talk through PTSD treatment at your pace.