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Evidence-Based Reviews

TRAUMATIZED TROOPS How to treat combat-related PTSD

Vol. 5, No. 5 / May 2006

Thousands of U.S. troops are seeking mental health care after being deployed in Iraq. Among 222,000 Army and Marine Iraq veterans, 35% sought treatment in the year after returning home—many for posttraumatic stress disorder (PTSD).In a related article, we discuss the diagnosis and treatment of military sexual trauma, a form of PTSD.

Persistent pathology

The greater the intensity of an Iraq/Afghanistan veteran’s combat experiences (“firefights”), the more likely the soldier is to develop PTSD.Traumatic brain injury: Choosing medications for neurobehavioral symptoms”). Sexual trauma also may cause or exacerbate PTSD.Military sexual trauma: How to identify and treat a unique form of PTSD”).

Table 1

3 domains of posttraumatic stress disorder symptoms




  • Recurrent, intrusive, distressing recollections or dreams of traumatic event
  • Acting or feeling as if the event were recurring
  • Intense psychological distress or physiologic reactions when exposed to internal or external cues

Avoidance and numbing

  • Efforts to avoid thoughts, feelings, or conversations about the trauma or activities, places, or people that arouse recollections
  • Inability to recall an important aspect of the trauma
  • Markedly less interest or participation in significant activities
  • Feeling detached or estranged from others
  • Restricted range of affect
  • Sense of a foreshortened future

Increased arousal

  • Difficulty falling or staying asleep
  • Irritability or angry outbursts
  • Difficulty concentrating
  • Hypervigilance
  • Exaggerated startle response

Source: DSM-IV-TR

FigurePTSD screen for war veterans

Source: U.S. Department of Veterans Affairs. Afghan & Iraq Post-Deployment Screen, Attachment B. Screening for risk factors associated with development of post-traumatic stress disorder (PTSD)

Cognitive therapy

Psychotherapy is the cornerstone of PTSD treatment; skilled therapists may achieve greater efficacy and more-durable results than medications do. Evidence strongly supports cognitive behavioral therapy—including exposure therapy, anxiety management, and cognitive therapy.U.S. troops returning home: Are you prepared? Current Psychiatry 2006;5(1):12-22.

Drug brand names



  • Carbamazepine • Carbatrol
  • Fluoxetine • Prozac
  • Lamotrigine • Lamictal
  • Lithium • Lithobid, others
  • Mirtazapine • Remeron
  • Paroxetine • Paxil
  • Prazosin • Minipress
  • Sertraline • Zoloft
  • Trazodone • Desyrel
  • Temazepam • Restoril
  • Valproic acid • Divalproex, others
  • Venlafaxine • Effexor
  • Zolpidem • Ambien



The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products. Drs. Lineberry, Bostwick, and Rundell served on active duty in the U.S. Air Force. Dr. Ramaswamy is staff psychiatrist, Omaha Veterans Administration. and Director of Psychopharmacology Research, Creighton University, Omaha, NE.


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