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

From the Guidelines

To prevent PTSD relapse, it is crucial to maintain consistent engagement with your established treatment plan, including regular therapy sessions and medication if prescribed, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1. The treatment plan should include specific manualized psychotherapies such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, which have been shown to be effective in preventing PTSD relapse. Some key points to consider in preventing PTSD relapse include:

• Practicing stress management techniques daily, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation for 10-15 minutes
• Identifying personal triggers and developing specific coping strategies for each
• Maintaining a strong support network and not hesitating to reach out when symptoms intensify
• Prioritizing healthy sleep habits by establishing a consistent bedtime routine and aiming for 7-9 hours nightly
• Limiting alcohol and avoiding recreational drugs as they can worsen symptoms and interfere with recovery
• Engaging in regular physical activity (30 minutes daily) to help reduce stress hormones and improve mood
• Contacting your healthcare provider immediately to adjust your treatment plan if you notice warning signs of relapse such as increased nightmares, hypervigilance, or avoidance behaviors. It is also important to note that medications such as paroxetine, sertraline, or venlafaxine may be prescribed to help regulate mood and reduce symptoms of PTSD, as recommended by the clinical practice guideline 1. However, it is essential to follow the guidance of your healthcare provider and adhere to the recommended treatment plan to ensure the best possible outcomes and prevent PTSD relapse. Additionally, brief cognitive-behavioral therapy (CBT) has been shown to be effective in speeding the rate of recovery and preventing the development of chronic PTSD in some studies 1. Overall, a comprehensive treatment plan that includes a combination of psychotherapy, medication, and lifestyle changes can help prevent PTSD relapse and improve 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 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 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 4
• CPT, which has been found to be effective in reducing PTSD symptoms 4
• CT, which has been found to be effective in reducing PTSD symptoms 4
• EMDR, which has been found to be effective in reducing PTSD symptoms 4
• PE, which has been found to be effective in reducing PTSD symptoms 4