What is the recommended treatment for post-traumatic stress disorder (PTSD) and social anxiety?

From the Guidelines

The most effective treatment for post-traumatic stress disorder (PTSD) and social anxiety is a combination of psychotherapy, such as cognitive behavioral therapy (CBT), and medication, including selective serotonin reuptake inhibitors (SSRIs) like sertraline and paroxetine. For psychotherapy, trauma-focused CBT, Prolonged Exposure therapy, and Eye Movement Desensitization and Reprocessing (EMDR) are considered first-line treatments for PTSD, while CBT with a focus on exposure therapy is most effective for social anxiety, as suggested by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1. Some key points to consider when treating PTSD and social anxiety include:

• Medication options for PTSD include SSRIs like sertraline (50-200 mg daily) and paroxetine (20-60 mg daily), which are FDA-approved for PTSD and can be continued for at least 6-12 months after symptom improvement.
• For social anxiety, SSRIs such as paroxetine (20-60 mg daily), sertraline (50-200 mg daily), or escitalopram (10-20 mg daily) are typically prescribed for at least 6-12 months, as recommended by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1.
• Treatment should be individualized, and combining therapy with medication often yields better results than either approach alone, with patients expecting several weeks before noticing significant improvement with medications, and therapy typically requiring 12-16 weekly sessions to show substantial benefits. The development of clinical practice guidelines for social anxiety disorder began in March 2018, and the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive–Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive–compulsive disorders, as described in the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1.

From the FDA Drug Label

Panic Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder Sertraline treatment should be initiated with a dose of 25 mg once daily After one week, the dose should be increased to 50 mg once daily.

The recommended treatment for Post-Traumatic Stress Disorder (PTSD) and Social Anxiety Disorder is sertraline, which should be initiated at a dose of 25 mg once daily and increased to 50 mg once daily after one week 2.

• The dose may be increased up to a maximum of 200 mg/day for patients who do not respond to the initial dose.
• Sertraline should be administered once daily, either in the morning or evening.
• The efficacy of sertraline in maintaining a response in adult patients with PTSD and Social Anxiety Disorder has been demonstrated for up to 28 weeks and 24 weeks, respectively, following initial treatment 2, 2.

From the Research

Treatment Options for PTSD and Social Anxiety

• The recommended treatment for post-traumatic stress disorder (PTSD) includes pharmacotherapy and psychotherapy, with selective serotonin reuptake inhibitors (SSRIs) being the most studied and effective medications 3.
• For social anxiety disorder, cognitive-behavioral therapy (CBT) is the most thoroughly studied nonpharmacologic approach, and its efficacy has been demonstrated in a large number of investigations 4, 5.
• First-line treatments for anxiety disorders, including social anxiety disorder, include pharmacotherapy with SSRIs (e.g., sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g., venlafaxine extended release), as well as CBT 6, 7.

Pharmacotherapy for PTSD and Social Anxiety

• SSRIs, such as sertraline and paroxetine, are US FDA-approved for PTSD and have been shown to be effective in short-term trials (6-12 weeks) 3.
• For social anxiety disorder, SSRIs (e.g., paroxetine, sertraline, fluoxetine) and SNRIs (e.g., venlafaxine) are effective treatments, with the additional benefit of being able to treat comorbid conditions 7.
• Other pharmacotherapy options for social anxiety disorder include benzodiazepines, alpha2delta calcium-channel blockers, reversible inhibitors of monoamine oxidase A, antiepileptics, and atypical antipsychotics 7.

Psychotherapy for PTSD and Social Anxiety

• CBT is the psychotherapy with the most evidence of efficacy for anxiety disorders, including social anxiety disorder, compared with psychological or pill placebo 6.
• CBT approaches, such as cognitive-behavioral group therapy (CBGT) and social effectiveness training (SET), have been shown to be effective in treating social anxiety disorder 4, 5.
• Exposure to feared situations is a key factor influencing treatment outcome for social anxiety disorder, and CBT programs that include exposure have been demonstrated to be effective 4, 5.