The dynamics of an open quantum system with balanced gain and loss is not described by a PT-symmetric Hamiltonian but rather by Lindblad operators. Nevertheless the phenomenon of PT-symmetry breaking and the impact of exceptional points can be observed in the Lindbladean dynamics. Here we briefly review the development of PT symmetry in quantum mechanics, and the characterisation of PT-symmetry breaking in open quantum systems in terms of the behaviour of the speed of evolution of the state.