Laura Wolfe, M.D., is an adult psychiatrist who works for Kaiser Permanente in Santa Clara, California. Her experience treating a man with PTSD is helpful in understanding the role of SSRIs.
Dr. Wolfe has disclosed that she has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
"My patient is a married man in his 50s, who was a marine in Vietnam for a one year tour of duty in the mid 1960s. After an honorable discharge, he became involved with abusing alcohol, cannabis, and cocaine, and became sober in the early 1990s. Once he became sober, he experienced symptoms including nightmares, avoidance, numbing, in addition to depression, phobias, and irritability. A psychiatrist started him on fluoxetine in 1996, and when I first saw him in 2002, he was on the same low dose of 20 mg QD, and remained symptomatic. I gradually increased his Prozac to 80 mg QD, and he showed a significant improvement, primarily in his symptoms of depression and anxiety, less so in the core PTSD symptoms. He also got very involved in different psychotherapies, including individual EMDR, group therapy at the VA, and marital therapy, and I think these have been more helpful for the PTSD core symptoms than the medication."