What are the most commonly used medications to treat Post-Traumatic Stress Disorder (PTSD)?

From the Guidelines

The most commonly used medications to treat Post-Traumatic Stress Disorder (PTSD) are selective serotonin reuptake inhibitors (SSRIs), particularly sertraline (Zoloft) and paroxetine (Paxil), which are FDA-approved specifically for PTSD. These medications are typically started at low doses (sertraline 25-50mg daily or paroxetine 10-20mg daily) and gradually increased as needed, with treatment generally continuing for at least 6-12 months after symptom improvement. Other SSRIs like fluoxetine (Prozac) and escitalopram (Lexapro) are also commonly prescribed off-label. For patients who don't respond adequately to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) may be used. Prazosin, an alpha-1 blocker, is sometimes prescribed specifically for PTSD-related nightmares at doses of 1-15mg before bedtime, as supported by studies such as 1 and 1. These medications work by regulating neurotransmitters like serotonin and norepinephrine, which help modulate mood, anxiety, and stress responses that are dysregulated in PTSD. It's essential to note that medication is most effective when combined with trauma-focused psychotherapy, and patients should be monitored for side effects and suicidal thoughts, especially during the initial weeks of treatment.

Some key points to consider when treating PTSD with medications include:

• Starting with low doses and gradually increasing as needed
• Continuing treatment for at least 6-12 months after symptom improvement
• Combining medication with trauma-focused psychotherapy for optimal results
• Monitoring patients for side effects and suicidal thoughts, especially during the initial weeks of treatment
• Considering the use of prazosin for PTSD-related nightmares, as supported by studies such as 1 and 1

It's also important to consider the potential interactions between medications, such as the interaction between prazosin and antidepressant medications, as noted in 1. Additionally, the American Academy of Sleep Medicine position paper 1 recommends the use of image rehearsal therapy for the treatment of PTSD-associated nightmares and nightmare disorder. Overall, the treatment of PTSD requires a comprehensive approach that incorporates medication, psychotherapy, and careful monitoring of patients to ensure the best possible outcomes.

From the FDA Drug Label

The effectiveness of sertraline in the treatment of PTSD was established in two multicenter placebo-controlled studies (Studies 1-2) of adult outpatients who met DSM-III-R criteria for PTSD The mean duration of PTSD for these patients was 12 years (Studies 1 and 2 combined) and 44% of patients (169 of the 385 patients treated) had secondary depressive disorder. Sertraline was shown to be significantly more effective than placebo on change from baseline to endpoint on the CAPS, IES and on the Clinical Global Impressions (CGI) Severity of Illness and Global Improvement scores

The most commonly used medication to treat Post-Traumatic Stress Disorder (PTSD) is sertraline.

• Key points:
  • Sertraline has been established as effective in the treatment of PTSD in two multicenter placebo-controlled studies.
  • The medication has been shown to be significantly more effective than placebo in improving symptoms of PTSD.
  • Sertraline is indicated for the treatment of PTSD in adults, as defined in the DSM-III-R category of PTSD 2 2 2

From the Research

Most Commonly Used Medications for PTSD

The most commonly used medications to treat Post-Traumatic Stress Disorder (PTSD) are:

• Selective serotonin reuptake inhibitors (SSRIs), with sertraline and paroxetine being US FDA-approved for PTSD 3, 4, 5, 6
• Other SSRIs, such as fluoxetine, have also been extensively studied and shown to be effective in short-term trials 3

Second-Line Treatment Options

If SSRIs are not tolerated or are ineffective, the following medications may be considered as second-line treatment:

• Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine 3
• Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin, which have shown positive results in open-label studies 3, 5
• Atypical antipsychotics, which have been shown to be effective in open-label/case studies and small double-blind, placebo-controlled trials 3, 4

Third-Line Treatment Options

The following medications may be considered as third-line treatment:

• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), which have been evaluated in a small number of double-blind, placebo-controlled studies, but have significant adverse effects and safety issues 3
• Benzodiazepines, which should be avoided or used only short-term due to potential depressogenic effects and the possibility that they may promote or worsen PTSD 3, 7

Other Treatment Options

Other medications that have been studied for the treatment of PTSD include:

• Buspirone, a non-benzodiazepine anxiolytic, which has been found to be effective in open-label studies 3
• Bupropion, a predominantly noradrenergic reuptake inhibitor, which was ineffective in PTSD in an open-label study 3
• Prazosin, an adrenergic-inhibiting agent, which is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms 7