Pharmacotherapy

The use of medication in addition to psychotherapy has been shown to be beneficial in the treatment of PTSD. Treatment is symptom related and essnetially depends on one of the following groups of drugs:

• Selective Serotonin Reuptake Inhibitors
• Serotonin and Noradrenaline Reuptake Inhibitors
• Tricyclic antidepressant
• Anxiolytics

Selective Serotonin Reuptake Inhibitors (SSRIs)

Based on the research evidence, SSRI antidepressants are the best first-line treatment for PTSD. The five SSRIs available in the United States are:

Right now one medication, sertraline (Zoloft), has FDA approval for treating PTSD. In Great Britain however Paroxetine (Seroxat) is the only one that is approved for use in PTSD. Other medications in the SSRI class are also probably effective—in fact, if one SSRI is ineffective or has intolerable side effects, a second SSRI may prove beneficial and well tolerated.

Serotonin is a neurotransmitter that helps transfer information from one brain cell (neuron) to another. Imbalances in serotonin are thought to play a major role in causing or continuing PTSD. Antidepressant medications may work by correcting these imbalances. The antidepressants known as SSRIs are unlike most other antidepressants in that they have little effect on neurotransmitters other than serotonin. Although quite different in their chemical structures, these medications share the property of inhibiting serotonin reuptake, so their modes of action and side effects are similar.

Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
High-dose nefazodone (Serzone®) therapy may help control intrusive and hyperarousal symptoms. In fact both  nefazodone (Serzone) and venlafaxine (Effexor) have shown promise as second-line treatment if SSRIs prove ineffective or are not well tolerated. They have a more favorable side-effect profile than the tricyclics.

While nefazodone (Serzone) and venlafaxine (Effexor and Effexor XR) are the recommended second-line medications for PTSD, it is possible that other antidepressants may also be helpful. We include them here because clinicians may prescribe them. These medications include:

Tricyclic antidepressants (TCA)

TCAs (e.g., clomipramine [Anafranil®]; doxepin [Sinequan®]) could be employed if the person has had a good response to them in the past and they do not cause too many side effects, or if the person has failed to respond to or does not tolerate the SSRIs, nefazodone or venlafaxine. They have been shown to reduce insomnia and dream disturbance, anxiety, guilt, flashbacks, and depression. Mood stabilizers (Lithium) may be added to improve a partial response to an antidepressant.

Anxiolytics (antianxiety agents)

Anxiolytics including benzodiazepines (e.g., diazepam [Valium®]; chlordiazepoxide [Librium®]) are ideally used only briefly and intermittently, if at all, to quell acute and severe anxiety symptoms. While they reduce anxiety rapidly, they also often induce sedation, impaired coordination and the development of physical dependency in those who use them for more than a few weeks and usually are not recommended as treatment for PTSD, because patients with this disorder are often predisposed to developing substance abuse. Gabapentin (Neurontin) is sometimes used in the place of benzodiazepines because it has similar benefits and does not cause dependency. Unfortunately, it is quite expensive. Buspirone [BuSpar®] has been shown to reduce anxiety, irritability, insomnia, and hypervigilance. However no studies have been done demonstrate long-term effectiveness.

Anticonvulsants

Anticonvulsants (Carbamazepine and Valproate) have shown promising effects in preliminary studies.

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