Common questions Veterans ask their providers

One of the concerns I hear the most is,

"If I come to therapy, does that mean I'm crazy?"

I think there's a big stigma out there about people who go

to therapy, that that means that they're crazy in some way,

and it really doesn't.

PTSD is, unfortunately, an all too common reaction

to traumatic experiences, and getting treatment,

getting help does not make one crazy.

In fact, it can help make one feel a lot more sane.

You might be wondering if it's too late for you to come in

for treatment, and I can tell you that many of the Veterans

that are in my PTSD clinic and that have been

in my research studies are older adults.

Many of them are in their mid-60s or 70s.

They've had PTSD for sometimes 40 years, and they have

responded really well to the treatments that we've got.

The treatments that we have are very powerful,

and they work well no matter what your age.

It's a really common fear that Veterans have

that they might lose control.

We actually find that that's not the case, that if anything,

being able to talk about it in a manageable way

will actually give you a better sense

of control and manageability.

It's a way to feel more empowered

and to take some of the control back.

In the past, there was some thinking that

you must treat substance abuse before you can treat PTSD.

Currently though, we have found and we continue to find

that both posttraumatic stress disorder

and substance use can be treated concurrently,

and it's only when there is severe levels of consistent

intoxication, meaning you get drunk all the time, you get high

all the time every day, that's when we

really have to focus on the substance abuse first.

Otherwise, it's best to get treatment and get treatment

as soon as possible for both.

Often, I hear concerns about, "Will medication change me?

Will it make me a different person?"

Sometimes, people tell me they fear being turned into a zombie.

Really, the reality of using medication for PTSD

is to alleviate some of the symptoms, to take the edge off

of some of the anxiety, some of the irritability.

When I feel medication is doing its job, what I hear from

Veterans is, some Veterans, for example, who have spouses

or partners, you may hear your spouse or partner say,

"It's nicer to be around you."

I have heard many people say,

"I don't sweat the small stuff as much,"

"I feel like I have more time to think before I react."

So medication really is about helping to feel more normal,

not abnormal, not like a zombie.

And I really encourage Veterans to talk very closely with me

about any problems that they're experiencing.

Those are side effects, and side effects can happen with any

medication, but side effects are not permanent.

And it's an indication that maybe it's not the right

medication for you, maybe we need to adjust the dose,

maybe we need to try a different medication.

For a medication to be worthwhile, it really should improve

your quality of life, and you really should be able to say,

"Yes, I do feel better taking this every day,

and it is worth my while to take this every day."

Another concern for you younger Vets, well, also older Vets,

but a particular concern for the younger Vets is that some of

the medications that we use can have sexual side effects.

In men, it can be trouble getting an erection or keeping

an erection, or sometimes it takes forever to have an orgasm.

For women, it can be the latter two, just the

level of arousal and also taking forever to have an orgasm.

If that happens to you, if you take a medication

and you have those sexual side effects,

then we're just going to stop the medication.

It will take about five, six days for your blood levels to drop,

and after that, your sexual functioning will return

to absolutely normal.

But that doesn't mean that if we try a different medication

we're going to have the same problem.

We can try lots of different medications,

and I have never had anybody get stuck

with a sexual side effect that we weren't able to

find a medication where they didn't have it.

So it's just like I said earlier,

it's just important to be patient and try different things,

and eventually we'll find things that work well for you.

You don't have to involve your family in PTSD treatment,

but it might be a lot more effective if you do.

But I want to be clear about this.

We're not interested in sharing the vivid, graphic,

gory details of combat trauma with your family.

We don't want to bring the war home to your living rooms.

I'm guessing that's a lot of the reason why you went to war

in the first place, was to sort of keep our country

and keep your family safe from that sort of stuff.

But we do want to integrate your family into the solution

of you re-engaging with your life.

For example, a lot of times families have learned

over the years not to ask Veterans to do things.

So maybe you used to be invited to go to the movies

with your grandson or your granddaughter,

but now they don't even bother inviting you anymore

because they know you're going to make up an excuse.

Or maybe your husband has just stopped asking you

to go to the store because he knows

that you're just going to say no.

And so what we'd like to do is we'd like to

get your idea about what you think would be helpful

for your family, and maybe we'll start there.

We'll start with the easier things.

We want to kind of pull your family into this idea

that our goal is that you don't have symptoms anymore

or that your symptoms are significantly reduced.

For that to happen, they're going to have to start

changing what they expect of you, and you're going to have to

kind of prove to them that you're different.

You're not going to be the grumpy guy in the corner

pushing people away.

That is, you're not going to be that guy for long

if you go through Prolonged Exposure therapy

because the whole essence of the treatment is to get you

re-engaged, and out living life, and a lot happier.

Many patients don't want to come to the VA and spend

all of their time in a doctor's office, and so a question

that they have is, "How long is this going to take?"

And I can say with confidence that most of the time,

treatment is going to take eight to 12 weeks.

And after that, they're on their way.

It's a weekly therapy, but for eight to 12 weeks.

Especially if a patient is willing to work hard,

they're going to be done after that point.

If the symptoms have been with you for quite a while

and they've really impaired

or they've really disrupted your life,

like gotten in the way of your work, of your relationships,

then the best thing to do is to find out more about PTSD

and to really seek help for it because there is help for it.

The important thing, and if you don't remember

anything else about what I say, is that PTSD is treatable.

We have excellent treatments, and the sooner you get

treatment, the sooner you can try to turn your life around.

I want you to be able to recognize that you may have PTSD

and to understand that if you do, that you should get help.

And if you're not sure, you should go to see someone like me

who can tell you whether you have PTSD.

Frankly, one of the happiest things that happens in my career

is when someone comes and says, "Do I have PTSD, Doc?"

and I say "No, you've got some problems that need to be

corrected, but you don't have PTSD,

and they're fairly easy to correct."

Other times, though, the person really does have PTSD,

and we want to get them in treatment, and we want

to get them in as quickly as possible because

we know that it can be a life-changing event.