Is it normal for patients to experience post-traumatic stress disorder (PTSD) symptom relapse?

From the Guidelines

Yes, it is normal for patients to experience trauma symptom relapse, with studies showing that between 26 and 52% of participants relapse when shifted to placebo after medication discontinuation. Trauma recovery is rarely a linear process, and many patients experience periods where symptoms return or intensify, even after significant improvement 1. These relapses often occur during times of stress, when encountering trauma reminders, during significant life transitions, or on anniversary dates related to the traumatic event. Common relapse symptoms include intrusive thoughts, nightmares, heightened anxiety, emotional numbness, or avoidance behaviors.

Key Points to Consider

• Trauma symptom relapse can occur even after successful treatment with medication, such as SSRIs like fluoxetine, sertraline, and paroxetine 1
• The likelihood of relapse is higher when medication is discontinued, with one study finding that 34% of participants shifted to placebo relapsed compared to 17% of participants maintained on fluoxetine 1
• Relapse can be triggered by various factors, including stress, trauma reminders, and significant life transitions
• Patients should be encouraged to maintain connection with support systems and consider reconnecting with a mental health provider if symptoms persist or significantly impact functioning
• Understanding that relapse is a normal part of recovery can help reduce shame and encourage patients to seek appropriate support when needed

Management of Relapse

When relapse occurs, patients should return to previously effective coping strategies such as grounding techniques, mindfulness practices, or breathing exercises. It's also important to reassess the treatment plan and consider restarting or adjusting medication, or adding other therapies like cognitive-behavioral therapy (CBT) 1. By acknowledging that relapse is a common aspect of trauma recovery, patients and healthcare providers can work together to develop strategies for managing symptoms and improving overall quality of life.

From the FDA Drug Label

The efficacy of sertraline in maintaining a response in adult patients with PTSD for up to 28 weeks following 24 weeks of open-label treatment was demonstrated in a placebo-controlled trial Nevertheless, the physician who elects to use sertraline for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient

The FDA drug label does indicate that relapse can occur in patients with PTSD who are being treated with sertraline. However, it does not provide information on whether it is normal for patients to experience trauma symptom relapse.

• The label mentions that the physician should periodically re-evaluate the long-term usefulness of the drug for the individual patient, implying that relapse is a possibility that needs to be monitored.
• It does not provide a clear answer to the question of whether trauma symptom relapse is normal in patients being treated with sertraline 2.

From the Research

Trauma Symptom Relapse

• Trauma symptom relapse is a common phenomenon in patients with post-traumatic stress disorder (PTSD) 3, 4.
• Studies have shown that patients with PTSD are at high risk of relapse, even after successful treatment 4, 5.
• The risk of relapse can be reduced with continuation and maintenance treatment, such as selective serotonin reuptake inhibitors (SSRIs) for 6-12 months 4.
• Trauma-focused psychotherapies, such as cognitive behavioral therapy, can also be effective in reducing PTSD symptoms and preventing relapse 6.

Factors Influencing Relapse

• The recovery process after a traumatic injury is complex and influenced by various psychosocial factors, including the patient's sense of self and engagement in the recovery process 7.
• Patients who are able to maintain or regain a cohesive sense of self after injury and who are highly engaged in the recovery process have more positive assessments of their outcomes 7.
• The use of SSRIs and other medications can also influence the risk of relapse, with some studies suggesting that these medications can be effective in reducing PTSD symptoms and preventing relapse 3, 4, 5.

Treatment Approaches

• Pharmacotherapy, such as SSRIs, and psychotherapy, such as trauma-focused cognitive behavioral therapy, are commonly used treatment approaches for PTSD 3, 4, 6, 5.
• The choice of treatment approach depends on various factors, including the patient's symptoms, medical history, and personal preferences 4, 6.
• A combination of pharmacotherapy and psychotherapy may be effective in reducing PTSD symptoms and preventing relapse 4, 6.