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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.
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Evidence:
- Several controlled studies support sedating TCAs and the monoamine oxidase inhibitor, phenelzine, for PTSD. Open trials support
nefazodone (34).
- 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 (25; 27; 35; 36; 37; 38).
- Prazosin has been associated with reductions in nightmares and global PTSD severity in small open trials (39; 40). Larger, controlled studies are warranted.
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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.
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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.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2008 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Posttraumatic Stress Disorder
> Drug Therapy
