From the Guidelines
The most effective medications for treating Post-Traumatic Stress Disorder (PTSD) are selective serotonin reuptake inhibitors (SSRIs), specifically paroxetine, sertraline, or venlafaxine, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.
Medication Options
- Paroxetine (Paxil) at 20-60 mg daily
- Sertraline (Zoloft) at 50-200 mg daily
- Venlafaxine (Effexor XR) at 75-225 mg daily These medications are preferred over pharmacotherapy due to their efficacy in reducing PTSD symptoms and improving quality of life 1.
Treatment Approach
- Medication should be combined with trauma-focused psychotherapy for comprehensive treatment
- Patients should be monitored for side effects such as nausea, headache, or sexual dysfunction, which often improve over time
- Benzodiazepines, cannabis, or cannabis-derived products are not recommended due to their potential for addiction and worsening of PTSD symptoms long-term 1.
Key Considerations
- The revised clinical practice guideline includes 34 recommendations, with six strong recommendations for PTSD treatment
- The guideline emphasizes the importance of evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life 1.
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 PAXIL is indicated for the treatment of Posttraumatic Stress Disorder (PTSD) The efficacy of PAXIL in the treatment of PTSD was established in two 12-week placebo-controlled trials in adults with PTSD (DSM-IV)
The medications for Post-Traumatic Stress Disorder (PTSD) are:
From the Research
Medications for Post-Traumatic Stress Disorder (PTSD)
The following medications are used to treat PTSD:
- Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine, which are considered first-line treatment for PTSD 4, 5, 6, 7, 8
- Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine, which can be considered as second-line treatment 4
- Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), which can be considered as third-line treatment due to their significant adverse effects and safety issues 4
- Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin, which can be considered for patients with co-morbidity of bipolar disorder or prominent impulsivity and anger 4, 7
- Atypical antipsychotics, which can be used as monotherapy or as an augmenter to SSRIs, particularly for patients with paranoia or flashbacks 4, 7
- Prazosin, which is effective for the treatment of PTSD-related sleep disturbance 7
Efficacy of Medications
Studies have shown that:
- SSRIs have a small but statistically significant effect in reducing PTSD symptoms 8
- Fluoxetine, paroxetine, and venlafaxine have small statistically significant evidence of efficacy for PTSD 8
- Other medications, such as MAOIs and TCAs, have inconsistent but promising results, while anticonvulsants and atypical antipsychotics have shown positive results in open-label studies 4, 5, 7