Hydrocortisone Has the Most Evidence for Preventing PTSD Symptoms
Among the somatic approaches listed, hydrocortisone (Option B) has moderate quality evidence supporting its efficacy in preventing PTSD onset, distinguishing it from other pharmacological agents that show limited benefit for prevention. 1
Evidence Hierarchy for PTSD Prevention
Hydrocortisone: The Strongest Evidence
- Hydrocortisone demonstrates a risk ratio of 0.17 (95% CI 0.05-0.56) for preventing PTSD onset across four trials with 165 participants, indicating that between 7 and 13 patients need treatment to prevent one case of PTSD. 2
- This represents moderate quality evidence, with three of four randomized controlled trials showing hydrocortisone was more effective than placebo in reducing PTSD symptoms after a median of 4.5 months post-trauma. 2
- The American Psychiatric Association and International Society for Traumatic Stress Studies distinguish hydrocortisone from other agents due to this moderate quality evidence supporting prevention efficacy. 1
Propranolol: Limited and Inconsistent Evidence
- Propranolol shows low quality evidence for preventing PTSD onset, with a risk ratio of 0.62 (95% CI 0.24-1.59, p=0.32) across three trials with 118 participants—this confidence interval crosses 1.0, indicating no statistically significant benefit. 2
- While one small 2002 pilot study (n=41) suggested potential benefit with fewer physiologic responders during trauma script imagery at 3 months (0 of 8 propranolol vs 6 of 14 placebo patients), this has not been consistently replicated. 3
- A 2021 randomized trial found no treatment difference between propranolol and placebo for PTSD symptoms, with both groups showing similar 34-39% symptom reduction. 4
- The guideline literature consistently notes that early propranolol administration has been found to be of limited benefit overall for preventing PTSD symptoms. 1
SSRIs: Treatment, Not Prevention
- SSRIs (sertraline and paroxetine) have FDA indication for treating established chronic PTSD, but there is no evidence supporting their use for preventing PTSD onset. 1
- The single trial of escitalopram for prevention demonstrated no evidence of superiority over placebo. 2
Other Agents Without Prevention Evidence
- Benzodiazepines show harmful effects, with 63% of patients receiving benzodiazepines developing PTSD at 6 months compared to only 23% receiving placebo. 5
- Temazepam and gabapentin single trials showed no evidence of preventing PTSD onset. 2
- Ketamine and albuterol are not mentioned in guideline literature for PTSD prevention. 5, 1
Critical Caveats
- All pharmacological prevention strategies have limited overall benefit, with secondary prevention (cognitive-behavioral interventions delivered post-trauma) having more robust evidence than medication approaches. 1, 6
- The hydrocortisone evidence base, while the strongest among medications, still derives from small studies with multiple methodological limitations, including high risk of bias in seven of nine included trials. 2
- Drop-outs due to treatment-emergent side effects were low for all tested agents where reported. 2
Answer: B. Hydrocortisone