From the Guidelines
A comprehensive PTSD relapse treatment plan should prioritize evidence-based psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing, over pharmacotherapy. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1, these therapies have been shown to be effective in treating PTSD.
When medication is necessary, selective serotonin reuptake inhibitors (SSRIs) like paroxetine or sertraline, or venlafaxine, are recommended 1. The guideline suggests that these medications can be used to help regulate mood and anxiety, but should not be the first line of treatment.
In addition to these therapies, secure video teleconferencing can be used to deliver recommended psychotherapy 1, which can be especially helpful for individuals who have difficulty accessing in-person treatment. It is also important to avoid the use of benzodiazepines, cannabis, or cannabis-derived products 1, as they have not been shown to be effective in treating PTSD and may even exacerbate symptoms.
Some key components of a PTSD relapse treatment plan include:
- Reconnecting with a mental health provider to adjust treatment approach
- Implementing stress management techniques, such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation
- Establishing a consistent sleep routine and engaging in regular physical activity
- Building a strong support network by reconnecting with trusted friends, family, or support groups
- Considering the use of prazosin to reduce nightmares, although this is not explicitly mentioned in the guideline 1.
Overall, the goal of a PTSD relapse treatment plan is to address the neurobiological dysregulation in PTSD, process traumatic memories, and rebuild coping skills, with a focus on evidence-based psychotherapies and medications.
From the Research
PTSD Relapse Treatment Plan
- The treatment of PTSD relapse involves a combination of psychotherapy and pharmacotherapy 2, 3, 4, 5, 6
- First-line treatment of PTSD involves psychotherapy, such as trauma-focused cognitive behavior therapy, with pharmacotherapy used for patients who have residual symptoms after psychotherapy or are unable or unwilling to access psychotherapy 3, 4, 6
- Selective serotonin reuptake inhibitors (SSRIs) are the most studied medications for PTSD and are effective in short-term trials, with continuation and maintenance treatment for 6-12 months decreasing relapse rates 2, 5
- Serotonin-norepinephrine reuptake inhibitors, such as venlafaxine, are also effective in treating PTSD symptoms 3, 5, 6
- Other pharmacotherapies, such as atypical antipsychotics and topiramate, may be helpful for residual symptoms 3, 6
- Prazosin is effective for the treatment of PTSD-related sleep disturbance 3
- Psychiatric comorbidities, particularly mood disorders and substance use, are common in PTSD and are best treated concurrently 3
Treatment Recommendations
- Evidence-based psychotherapies, such as cognitive-behavioral therapies and Eye Movement Desensitization and Reprocessing, are recommended as first-line interventions 4, 6
- Pharmacotherapies, such as SSRIs and serotonin-norepinephrine reuptake inhibitors, can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference 2, 3, 5, 6
- Treatment should be tailored to the individual patient, taking into account their specific symptoms and needs 6