When the Nightmares Won't Go Away

Help for those still suffering stress from September 11

In the days after the September 11 attacks, a RAND Corp. survey found that 90% of Americans were suffering from stress related to the horrific events. Many have recovered. But for perhaps a third of those most directly affected--survivors, relatives of those who died, rescue workers--the misery continues. It has turned into chronic post-traumatic stress disorder (PTSD).

Characterized by sleep disruption, flashbacks, and a desire to avoid any reminder of the occurrence, this condition is considered chronic if symptoms persist beyond three months. After six months, they stand an increased chance of becoming permanent. That's why anyone with serious symptoms--whether related to September 11 or some other traumatic event--should seek help. Also, new studies suggest that chronic stress may be linked to biological changes in parts of the brain associated with fear and memory. The brain may essentially start overreacting, causing repeated release of fear hormones and creating a vicious cycle of stress.

Among those suffering from September 11 fallout is a 40-year-old New York firefighter who asked not to be identified. He was off-duty but rushed to the World Trade Center in time to watch the second tower fall. He spent the next three days crawling over the rubble, looking for friends he will never see again. Then came dreams of planes hitting buildings, of himself riding one of the towers down, of being in a room and hearing himself called up to die. Along with difficulty sleeping, he felt jumpy and emotionally detached--both classic PTSD symptoms. For two months, the firefighter used sleeping pills as he rotated among work, Ground Zero searches, and funerals for friends. Then he went to a therapist. "Not much has gotten easier, but I am not as depressed," he says now. "I'm having better days."

From 40% to 80% of those with PTSD also suffer symptoms of depression, says Dr. Robert Ursano, a psychiatrist at the Uniformed Services University School of Medicine, a military medical school in Bethesda, Md. That complicates the problem, he says, since depressed people often withdraw and don't seek treatment.

In addition, many of the firefighters and investment bankers affected come from work cultures where there's a reluctance to show weakness, says Karen Binder-Brynes, a Manhattan psychologist who's treating several. As New York's economy teetered after the attacks and layoffs mounted, some execs worried that admitting distress might make them targets in a job cut.

While some disagree, Ursano believes delay in getting therapy or medication to treat the disorder increases the odds that a patient will never recover. In fact, 10% of PTSD sufferers don't, according to studies of veterans, says Dr. Roy Lubit, a psychiatrist at Saint Vincent's Hospital & Medical Center in lower Manhattan. But new treatments may improve the odds. Rachel Yehuda, director of the PTSD program at the Bronx Veterans Affairs Medical Center in New York, is studying a new therapy that focuses on having victims confront their memories rather than go through traditional, supportive counseling.

Medications such as Zoloft and Paxil, which increase mood-improving serotonin in the brain, can be effective. Other drugs treat sleep disturbance. PTSD sufferers may need additional help for the marital difficulties, increased smoking, and alcohol and drug abuse they often develop.

Even those who thought they'd left the stress behind may face reminders. Rob White, a project manager in Amdahl's Sunnyvale (Calif.) office, was in Manhattan that day. Outside as the towers came down, he ran through the choking dust. He has been mostly O.K. since. Then, in February, he flew to New York. Nearing the city, he was flooded with anxiety, imagining what it would be like to fly into a building. Even for those without PTSD, there will be those moments.

By Carol Marie Cropper

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