What are the treatment options for Post-Traumatic Stress Disorder (PTSD) medications that cause nausea and malaise?

From the Guidelines

If you're experiencing nausea and malaise from PTSD medication, contact your healthcare provider as these side effects can often be managed. Common PTSD medications like SSRIs (sertraline, paroxetine, fluoxetine) and SNRIs (venlafaxine, duloxetine) frequently cause these symptoms, especially during the first few weeks of treatment 1. To reduce nausea, take your medication with food, eat smaller, more frequent meals, stay hydrated, and avoid spicy or greasy foods. Your doctor might recommend taking the medication at a different time of day, temporarily reducing the dose, or switching to a different medication if symptoms persist. Over-the-counter remedies like ginger supplements or prescription anti-nausea medications may help in the short term. Don't stop your medication abruptly as this can cause withdrawal symptoms and worsen your PTSD. These side effects often improve within 2-4 weeks as your body adjusts to the medication, but persistent or severe symptoms should be reported to your doctor immediately.

Some key points to consider:

• The 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline recommends use of specific manualized psychotherapies over pharmacotherapy for PTSD treatment 1.
• Medications such as paroxetine, sertraline, or venlafaxine are recommended for PTSD treatment, but may cause nausea and malaise as side effects 1.
• Anti-nausea medications such as ondansetron, granisetron, or aprepitant may be used to manage nausea and vomiting associated with gastroparesis or other conditions, but their use in PTSD treatment is not well established 1.

It's essential to work closely with your healthcare provider to manage any side effects and find the best treatment approach for your PTSD. Always prioritize your health and well-being by reporting any persistent or severe symptoms to your doctor immediately.

From the FDA Drug Label

In the tabulations that follow, a World Health Organization dictionary of terminology has been used to classify reported adverse events. ... PTSD Body System/Adverse Event Sertraline (N=374) Placebo (N=376) ... Gastrointestinal Disorders Nausea 21% ... General Fatigue 10% Malaise 10%

Nausea and Malaise are reported as treatment-emergent adverse events in patients with PTSD taking sertraline.

• Nausea is reported in 21% of patients taking sertraline.
• Malaise is reported in 10% of patients taking sertraline.
• General Fatigue is also reported in 10% of patients taking sertraline. 2

From the Research

PTSD Medication Side Effects

• Nausea and malaise are potential side effects of PTSD medication, although the provided studies do not directly address these specific side effects in relation to PTSD medication 3, 4, 5, 6.
• The studies focus on the effectiveness of various medications for PTSD, including SSRIs, non-SSRIs, and other classes of drugs 3, 4, 5, 6.
• One study found that SSRIs, such as sertraline and paroxetine, are effective in reducing PTSD symptoms, but may have adverse effects, including withdrawal due to adverse events 5.
• Another study suggested that nausea in the peri-traumatic period may be associated with an increased risk of developing PTSD symptoms, but this is not directly related to medication side effects 7.

Medication Options for PTSD

• SSRIs, such as sertraline, paroxetine, and fluoxetine, are commonly used to treat PTSD and have been shown to be effective in reducing symptoms 3, 4, 5, 6.
• Non-SSRIs, such as venlafaxine and mirtazapine, may also be effective in treating PTSD, although the evidence is less robust 3, 5.
• Other classes of drugs, including anticonvulsants and atypical antipsychotics, may be used to treat PTSD, particularly in cases where co-morbidities are present or where other medications are ineffective 3, 5.

Adverse Effects of PTSD Medication

• The studies suggest that SSRIs may have adverse effects, including withdrawal due to adverse events, although the absolute proportion of individuals dropping out of treatment due to adverse events is low 5.
• Other medications, such as tricyclic antidepressants and monoamine oxidase inhibitors, may have significant adverse effects, including cardiovascular complications and safety issues 3, 6.