What FDA‑approved medications are available for treating post‑traumatic stress disorder and what are their recommended dosing regimens?

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Last updated: February 18, 2026 • View editorial policy

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FDA-Approved Medications for PTSD

Only two medications have FDA approval for PTSD: sertraline and paroxetine. These selective serotonin reuptake inhibitors (SSRIs) are the sole pharmacologic agents with regulatory indication for post-traumatic stress disorder in the United States. 1, 2, 3

FDA-Approved First-Line Medications

Sertraline

  • Starting dose: 25 mg daily, titrate to target dose of 50-200 mg daily 4, 3
  • Evidence base: Demonstrated efficacy in large-scale, well-designed placebo-controlled trials with 53-85% response rates 4, 5
  • Advantages: Favorable discontinuation profile with lower risk of withdrawal syndrome compared to paroxetine; preferred in young adults due to better tolerability 5

Paroxetine

  • Starting dose: 10 mg daily for panic disorder presentations; 20 mg daily for PTSD 1
  • Target dose: 20-40 mg daily (established effective range) 1
  • Maximum dose: 60 mg daily, though evidence does not suggest additional benefit above 40 mg daily 1
  • Titration: Increase in 10 mg increments at intervals of at least 1 week 1
  • Evidence base: FDA-approved based on controlled trials demonstrating efficacy across PTSD symptom clusters 6, 1, 2
  • Cautions: Higher rates of discontinuation syndrome and more anticholinergic effects than other SSRIs; requires careful tapering if discontinuation becomes necessary 5

Treatment Duration and Maintenance

  • Minimum treatment duration: Continue for 6-12 months after symptom remission to prevent relapse 4, 5, 3
  • Relapse rates with discontinuation: 26-52% of patients relapse when shifted from sertraline to placebo, compared to only 5-16% maintained on medication 4
  • Long-term maintenance: PTSD is recognized as a chronic condition; continuation of treatment is reasonable for responding patients with periodic reassessment 1

Critical Implementation Points

Trauma-focused psychotherapy should be initiated immediately alongside or before medication, as it demonstrates superior durability with 40-87% of patients no longer meeting PTSD criteria after 9-15 sessions of Prolonged Exposure, Cognitive Processing Therapy, or EMDR. 4, 5 Relapse rates are substantially lower after completing CBT compared to medication discontinuation. 4

Medications to Avoid

  • Benzodiazepines: Strongly contraindicated—63% of patients receiving benzodiazepines developed PTSD at 6 months compared to only 23% receiving placebo 4, 5
  • Bupropion: Not recommended; failed to demonstrate efficacy in controlled trials and is omitted from evidence-based PTSD treatment guidelines 4
  • Psychological debriefing: Single-session interventions within 24-72 hours post-trauma are not supported by evidence and may be harmful 6, 4

Adjunctive Medication for Specific Symptoms

Prazosin (Not FDA-Approved for PTSD)

  • Indication: PTSD-related nightmares specifically (Level A evidence from American Academy of Sleep Medicine) 4, 5
  • Dosing: Start 1 mg at bedtime, titrate by 1-2 mg every few days to average effective dose of 3 mg (range 1-13 mg) 4
  • Monitoring: Assess for orthostatic hypotension during titration 4, 5

Treatment Algorithm

  1. Week 0-1: Initiate sertraline 25-50 mg daily OR paroxetine 10-20 mg daily; schedule first trauma-focused psychotherapy session within 2 weeks 4, 5

  2. Week 2-4: Titrate sertraline to 100-150 mg daily OR paroxetine to 20-40 mg daily based on tolerability; begin weekly trauma-focused therapy (PE, CPT, or EMDR) 4, 1

  3. Week 4-8: Optimize SSRI dose (sertraline 150-200 mg or paroxetine 20-40 mg); continue weekly trauma-focused therapy; monitor symptom response 4, 1

  4. Week 8-12: If nightmares persist despite SSRI treatment, add prazosin 1 mg at bedtime and titrate to effective dose 4, 5

  5. Month 3-6: Continue trauma-focused therapy until protocol completion (typically 12-17 sessions); maintain SSRI at effective dose 4

  6. Month 6-12: Maintain SSRI for minimum 6-12 months after remission before considering gradual taper 4, 5, 3

Common Pitfalls

  • Do not delay trauma-focused therapy for a "stabilization phase"—evidence shows immediate initiation yields better outcomes even with comorbid depression, panic symptoms, or suicidal ideation 4, 5
  • Do not use paroxetine as first choice in young adults (under age 25) due to higher risk of treatment-emergent suicidality and discontinuation syndrome; sertraline is preferred 5
  • Do not discontinue SSRIs abruptly—gradual tapering is essential, particularly with paroxetine which has the highest discontinuation syndrome risk among SSRIs 5, 1
  • Do not use doxazosin instead of prazosin for nightmares—only prazosin has Level A evidence for PTSD-related nightmares 5

Monitoring Requirements

  • Weeks 0-8: Monitor for treatment-emergent suicidality, particularly in patients under age 25 (black box warning applies) 5
  • Ongoing: Assess PTSD symptom severity using standardized scales at 4-6 week intervals 5
  • With prazosin: Monitor blood pressure for orthostatic hypotension during titration 4, 5

References

2
Research

Current concepts in pharmacotherapy for posttraumatic stress disorder.

Psychiatric services (Washington, D.C.), 2004

4
Guideline

Treatment of Post-Traumatic Stress Disorder (PTSD)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

PTSD and Panic Attack Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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