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- Treat PTSD with an antidepressant.
- Consider switching antidepressants or adding a second medication if the response to an SSRI is inadequate.
- Recognize that benzodiazepines offer minimal benefit and should be considered as adjunctive therapy for only a limited number of patients with PTSD.
| | Drug Treatment for Posttraumatic Stress Disorder (table)
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Treat PTSD with an antidepressant.  |
- Start treatment with one of the selective serotonin reuptake inhibitors with a low dose and gradually titrate to best efficacy.
- Look for some reduction in symptoms after 3 to 6 weeks on a therapeutic dose of medication.
- See table Drug Treatment for Posttraumatic Stress Disorder.
| Background | Back to top
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Consider switching antidepressants or adding a second medication if the response to an SSRI is inadequate.  |
- Choose nefazodone, trazodone, or a sedating tricyclic antidepressant as an alternative to an SSRI.
- Note that trazodone and the sedating TCAs may be used as adjuncts to the SSRIs, particularly for insomnia.
- Start with low doses; serum TCA levels will be increased when coadministered with fluoxetine, paroxetine, fluvoxamine, or, to a lesser extent, sertraline.
- Consider venlafaxine and mirtazapine as second alternatives to SSRIs (due to limited data on efficacy).
- In difficult cases, consider phenelzine.
- Consider prazosin as an adjunctive therapy in patients with a partial response to first-line treatments, especially for sleep-related symptoms.
- See table Drug Treatment for Posttraumatic Stress Disorder.
| Background | Back to top
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Recognize that benzodiazepines offer minimal benefit and should be considered as adjunctive therapy for only a limited number of patients with PTSD.  |
- Consider adding a benzodiazepine to an antidepressant for carefully selected patients with prominent generalized anxiety or insomnia.
- Weigh possible benefits of a benzodiazepine against the potential for tolerance and abuse when treating chronic PTSD.
- See table Drug Treatment for Posttraumatic Stress Disorder.
| Background | Back to top
| | | FAQs |
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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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Posttraumatic Stress Disorder
