From the Guidelines
A one-time PTSD flare-up should be treated, especially if significant milestones are approaching, to prevent symptoms from becoming chronic or more severe. This is based on the most recent and highest quality study, which recommends the use of specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, over pharmacotherapy 1.
When considering treatment options, it's essential to note that the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline recommends against the use of benzodiazepines, cannabis, or cannabis-derived products 1. Instead, medications like SSRIs (sertraline 50-200mg daily or paroxetine 20-60mg daily) may be considered if symptoms are severe.
Some key points to consider when managing a one-time PTSD flare-up include:
- Speaking with a mental health professional to determine appropriate care
- Using grounding techniques, deep breathing, and mindfulness for immediate relief during flare-ups
- Creating a safety plan before upcoming milestones related to trauma, including identifying support people to contact and self-care strategies
- Considering trauma-focused cognitive behavioral therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR) as treatment options
It's crucial to prioritize the individual's health outcomes and quality of life when making treatment decisions, and to use evidence-based, patient-centered care and shared decision making to optimize outcomes 1. By taking a proactive approach to managing PTSD symptoms, individuals can reduce the risk of chronic or severe symptoms and improve their overall well-being.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
PTSD Treatment
- Post-traumatic stress disorder (PTSD) is a chronic psychological disorder that can develop after exposure to a traumatic event 2.
- There is strong research evidence to support the pharmacological treatment of PTSD as a second line to trauma-focused psychological interventions 3.
- First-line treatment of PTSD involves psychotherapy, such as trauma-focused cognitive behavior therapy, while pharmacotherapy is useful for patients who have residual symptoms after psychotherapy or are unable or unwilling to access psychotherapy 4.
One-Time Flare-Up and Milestones
- A one-time flare-up of PTSD symptoms may require treatment, especially if it interferes with daily life or upcoming milestones 4.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective in treating primary PTSD symptoms, and may be considered for patients with residual symptoms after psychotherapy 3, 4.
- The addition of other pharmacotherapy, such as atypical antipsychotics or topiramate, may be helpful for residual symptoms, and prazosin is effective for the treatment of PTSD-related sleep disturbance 4.
Treatment Response
- Predictors of treatment response to SSRIs in patients with PTSD include symptom severity, childhood sexual trauma, and sexual assault as index trauma 5.
- Latent classes of treatment response have been identified, including fast responders, responders with low pretreatment symptom severity, and responders with high pretreatment symptom severity 5.
- Class membership is predicted based on time since index trauma, severity of depression, and severity of anxiety, and patients with longer time since index trauma may particularly benefit from treatment with sertraline or paroxetine 5.