Pharmacotherapy for posttraumatic stress disorder in adults
- Murray B Stein, MD, MPH
Murray B Stein, MD, MPH
- Editor-in-Chief — Psychiatry
- Section Editor — Anxiety Disorders
- Professor of Psychiatry and Family Medicine & Public Health
- University of California San Diego
Posttraumatic stress disorder (PTSD) is a severe, often chronic and disabling disorder, which develops in some persons following exposure to a traumatic event involving actual or threatened injury to themselves or others. PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction.
Effective treatments for PTSD include medications and psychotherapies. However, a substantial proportion of patients have symptoms resistant to treatment. It is often necessary to switch or combine treatments to achieve a satisfactory therapeutic response.
The pharmacological treatment of PTSD is addressed in this topic. The epidemiology, pathophysiology, clinical manifestations, and diagnosis of PTSD are discussed separately, as is psychotherapy for PTSD. The epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of acute stress disorder are also discussed separately. (See "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Psychotherapy for posttraumatic stress disorder in adults" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Treatment of acute stress disorder in adults".)
Treatment should optimally be initiated shortly after diagnosis. The diagnosis of PTSD is made after persistence of symptoms for at least four weeks following the trauma, but most patients present for treatment many months, or sometimes years, later. In theory, early treatment of PTSD may prevent chronicity, but this not been shown empirically, particularly for pharmacotherapy .
The therapeutic goals of pharmacologic therapy are to decrease intrusive thoughts and images, phobic avoidance, pathological hyperarousal, hypervigilance, irritability and anger, and depression. Drug therapies have generally been most effective in decreasing hyperarousal and mood (irritability, anger, depression) symptoms, and somewhat less effective for the symptoms of re-experiencing, emotional numbing, and behavioral avoidance, but individual differences in response generally outweigh treatment-specific differences. There is a great deal of variation in response to pharmacologic treatment, with few robust individual predictors of response available [2,3]. Some ancillary symptoms of PTSD, such as sleep disturbance, can be particularly difficult to treat, and are among the symptoms that result in the use of polypharmacy that is so common in the treatment of PTSD [4,5].
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- Selective serotonin reuptake inhibitors
- - Administration
- Serotonin-norepinephrine reuptake inhibitors
- Other antidepressants
- Second-generation antipsychotics
- - Efficacy
- - Administration
- Alpha-adrenergic receptor blockers
- Beta-adrenergic receptor blockers
- Mood stabilizers
- COMPARING PHARMACOTHERAPY AND PSYCHOTHERAPY
- COMBINING PHARMACOTHERAPY AND PSYCHOTHERAPY
- SSRI antidepressants
- Stepped care in trauma surgery center
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS