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Posttraumatic Stress Disorder > Drug Therapy Author: Jeffrey P. Staab, MD, MS
Editorial changes - 2010-01-20
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Rationale:

  • SSRIs do not benefit all patients with PTSD; some do better with more sedating medications, and they may need doses at the higher end of the safe-dose range.

Evidence:

  • Several controlled studies support sedating TCAs and the monoamine oxidase inhibitor, phenelzine, for PTSD. Open trials support nefazodone (35).
  • There is less evidence for the use of venlafaxine and mirtazapine. No substantive data support the use of buspirone, and no data are available on strategies for adding or substituting medications (26; 28; 36; 37; 38; 39).
  • Prazosin has been associated with reductions in nightmares and global PTSD severity in small open trials (40; 41). Larger, controlled studies are warranted.
  • A systematic review of evidence supporting pharmacologic intervention in patients who fail to respond to or do not tolerate SSRIs found that risperidone had the best evidence to favor its use in an adjunctive role (24).

Comments:

  • The insomnia of chronic PTSD can be resistant to medication. Older antipsychiatric agents are not recommended and data are limited regarding newer ones such as risperidone and olanzapine.

FAQs
Jeffrey P. Staab, MD, MS, is a consultant for Eli Lilly, Forest Laboratories, received honorarium from Abbott Laboratories, received grants from GlaxoSmithKline, Pfizer. Michael Roy, MD, editorial consultant, received honorarium from PFizer.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given.

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