What strategies can prevent Post-Traumatic Stress Disorder (PTSD) relapse?

From the Guidelines

Preventing PTSD relapse requires a comprehensive approach that combines professional treatment with self-management strategies, with a strong emphasis on evidence-based psychotherapies like Cognitive Processing Therapy (CPT), Prolonged Exposure therapy, or Eye Movement Desensitization and Reprocessing (EMDR) as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1. To prevent PTSD relapse, it is essential to maintain regular sessions with your therapist to continue practicing these evidence-based treatments. If prescribed, take medications consistently, which may include SSRIs like sertraline (50-200mg daily) or paroxetine (20-60mg daily), or prazosin (starting at 1mg and potentially increasing to 15mg at bedtime) for nightmares, as these have been shown to be effective in managing PTSD symptoms 1. Some key strategies to prevent relapse include:

• Developing a personalized relapse prevention plan with your therapist that identifies your specific triggers and early warning signs.
• Practicing stress management techniques daily, such as deep breathing, progressive muscle relaxation, or mindfulness meditation for 10-15 minutes.
• Maintaining healthy lifestyle habits including regular exercise (30 minutes most days), consistent sleep patterns (7-9 hours nightly), and avoiding alcohol and drugs which can worsen symptoms.
• Building a strong support network of trusted individuals who understand your condition, and considering joining a PTSD support group. These approaches work by helping regulate your nervous system, process traumatic memories, challenge unhelpful thought patterns, and provide you with tools to manage symptoms before they escalate into a full relapse. It is also important to note that the CPG recommends against the use of benzodiazepines, cannabis, or cannabis-derived products due to their potential to worsen symptoms or lead to dependency 1. By following these strategies and working closely with your therapist, you can reduce the risk of PTSD relapse and improve your overall quality of life.

From the FDA Drug Label

Patients receiving continued sertraline treatment experienced significantly lower relapse rates over the subsequent 28 weeks compared to those receiving placebo. To prevent PTSD relapse, continued treatment with sertraline is recommended, as it has been shown to significantly lower relapse rates compared to placebo 2.

• The dose of sertraline needed for maintenance treatment is not known to be identical to the dose needed to achieve an initial response.
• Patients should be periodically reassessed to determine the need for maintenance treatment 2.

From the Research

Prevention of PTSD Relapse

To prevent PTSD relapse, several strategies can be employed, including:

• Continuation and maintenance treatment with selective serotonin reuptake inhibitors (SSRIs) for 6-12 months, which has been shown to decrease relapse rates 3
• Trauma-focused psychological interventions, such as cognitive behavioural therapy with a trauma focus (CBT-TF), cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation and reprocessing (EMDR), and prolonged exposure (PE) 4
• Pharmacological approaches, including SSRIs, serotonin-potentiating non-SSRIs, and anticonvulsants, which have been found to be effective in reducing PTSD symptoms 3, 5, 6

Medications for PTSD Relapse Prevention

The following medications have been found to be effective in preventing PTSD relapse:

• SSRIs, such as sertraline, paroxetine, and fluoxetine, which are considered first-line treatment for PTSD 3, 5, 6
• Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine, which have been found to be effective in reducing PTSD symptoms 3
• Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin, which have been found to be effective in reducing PTSD symptoms, particularly in patients with co-morbid bipolar disorder 3

Psychological Interventions for PTSD Relapse Prevention

The following psychological interventions have been found to be effective in preventing PTSD relapse:

• CBT-TF, which has been found to be effective in reducing PTSD symptoms and preventing relapse 4
• CPT, CT, EMDR, and PE, which have been found to be effective in reducing PTSD symptoms and preventing relapse 4
• Early interventions, such as CBT-TF, CT, and EMDR, which have been found to be effective in reducing PTSD symptoms and preventing relapse 4