Rationale:

• The SSRIs are relatively easy to use and can reduce a variety of PTSD symptoms.
• Medications should not be expected to eliminate symptoms.

Evidence:

• A number of studies, including controlled trials, support the efficacy of SSRIs for reducing symptoms of PTSD. Open-label and placebo-controlled trials of SSRIs show gradual improvement in all types of PTSD symptoms (i.e., reexperiencing, avoidance, numbing, and hyperarousal) over several weeks of treatment (1; 24; 25; 26; 27; 28; 29; 30; 31).
• In 1-year, double blind, placebo-controlled trials, maintenance treatment with both sertraline and fluoxetine has been shown to reduce relapse rates and time to relapse (32; 33).

Comments:

• The benefits of drug therapy for PTSD are modest for most patients. However, some obtain substantial relief from medications. At present, there are no convincing data to favor any of the SSRIs over the others as the first treatment choice.
• Some studies suggest that treatment with SSRIs might slightly increase the rate of suicide attempts. Although the safety profile of SSRIs makes successful suicide less likely than with some other classes of antidepressants, and it remains controversial whether suicide attempts are more likely with SSRIs than with other psychotropic medications, it is important to follow patients closely for suicidal ideation during treatment.