From the Guidelines
Treatment for patients with anxiety, possible PTSD, and somatizing symptoms should prioritize a combination of psychotherapy and medication, with a focus on cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) as first-line options. The most recent and highest quality study, 1, recommends the use of specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, over pharmacotherapy. For medication, SSRIs such as paroxetine, sertraline, or venlafaxine are recommended.
Some key points to consider in treatment include:
- The use of CBT, trauma-focused CBT, and EMDR therapy, with 12-16 weekly sessions recommended
- The use of SSRIs, such as sertraline (starting at 25-50mg daily, gradually increasing to 100-200mg) or paroxetine (starting at 10-20mg daily, increasing to 20-60mg), as first-line medication options
- The importance of stress management techniques, regular physical activity, and adequate sleep hygiene in a comprehensive treatment approach
- The need for regular follow-up appointments, every 2-4 weeks initially, to monitor treatment response and adjust the approach as needed
It's also important to note that benzodiazepines, cannabis, or cannabis-derived products are not recommended for treatment, as stated in 1. Instead, a comprehensive approach that prioritizes psychotherapy and SSRIs, while incorporating stress management and lifestyle modifications, is likely to yield the best outcomes for patients with anxiety, possible PTSD, and somatizing symptoms.
From the FDA Drug Label
Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of posttraumatic stress disorder in adults The efficacy of sertraline in the treatment of PTSD was established in two 12-week placebo-controlled trials of adult outpatients whose diagnosis met criteria for the DSM-III-R category of PTSD PTSD, as defined by DSM-III-R/IV, requires exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others, and a response which involves intense fear, helplessness, or horror The efficacy of sertraline in maintaining a response in adult patients with PTSD for up to 28 weeks following 24 weeks of open-label treatment was demonstrated in a placebo-controlled trial
Treatment Recommendations:
- Sertraline is indicated for the treatment of posttraumatic stress disorder (PTSD) in adults.
- The efficacy of sertraline in treating PTSD was established in two 12-week placebo-controlled trials.
- For patients with anxiety and possible PTSD, sertraline may be a suitable treatment option.
- However, for patients with somatizing symptoms, the FDA drug label does not provide direct guidance on the use of sertraline.
- It is essential to note that sertraline is also indicated for the treatment of panic disorder, obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder.
- The dosage of sertraline for PTSD is not explicitly stated, but the typical dose range for adults is 50-200 mg/day 2.
- Patients should be periodically reassessed to determine the need for maintenance treatment 2.
From the Research
Treatment Recommendations for Patients with Anxiety, Possible PTSD, and Somatizing Symptoms
- The treatment of post-traumatic stress disorder (PTSD) often involves a combination of pharmacotherapy and psychotherapy 3, 4, 5.
- Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for PTSD due to their efficacy in reducing symptoms and relatively favorable adverse effect profile 3, 4.
- SSRIs such as sertraline, paroxetine, and fluoxetine have been extensively studied and are US FDA-approved for PTSD 3.
- Non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine, may be considered as second-line treatment if SSRIs are not tolerated or ineffective 3.
- Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin, may be considered for patients with co-morbid bipolar disorder or prominent impulsivity and anger 3.
- Atypical antipsychotics, such as quetiapine, may be effective in reducing PTSD symptoms, particularly in patients with prominent paranoia or flashbacks 6.
- Cognitive behavioral therapy (CBT) may be an effective next-step strategy for patients with SSRI-resistant social anxiety disorder, which often co-occurs with PTSD 7.
Pharmacotherapy Options
- SSRIs: sertraline, paroxetine, fluoxetine 3, 4
- Non-SSRIs: venlafaxine, nefazodone, trazodone, mirtazapine 3
- Anticonvulsants: carbamazepine, valproic acid, topiramate, gabapentin 3
- Atypical antipsychotics: quetiapine 6