Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: Jan 01, 2013

Post traumatic stress disorder toolbox

PharmD, BCPP
Page Range: 179 – 183
DOI: 10.9740/mhc.n132154
Save
Download PDF
Keywords: post traumatic stress disorder; medications; treatment guidelines; rating scales

This toolbox contains several helpful references to assist in choosing optimal treatments for the treatment of PTSD. The resources in this toolbox include three sections:

  1. PTSD Pharmacotherapy: Charts of medications commonly used for the treatment of patients with PTSD

  2. PTSD Rating Scales

  3. Medication Treatment Guidelines Summary for Post Traumatic Stress Disorder (PTSD)

PTSD PHARMACOTHERAPY

Table 1. Medications Approved by the Food and Drug Administration (FDA)
Table 1.
Table 2. Medications with Evidence Supporting Use in Treatment of PTSD, without FDA approval
Table 2.
Table 3. Medications Studied for the Prevention of PTSD, without FDA approval
Table 3.
Table 4. Currently being studied
Table 4.

PTSD RATING SCALES

Table 5. PTSD Rating Scales
Table 5.

MEDICATION TREATMENT GUIDELINES SUMMARY FOR POST TRAUMATIC STRESS DISORDER (PTSD)

The Veterans Affairs/Department of Defense –updated 20101

  1. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have a strong recommendation as first line therapy (significant benefit)

  2. Second line options include mirtazapine, prazosin (for nightmares), tricyclic antidepressants (TCAs), nefazodone, and monoamine oxidase inhibitors (MAOIs, i.e. phenelzine). These agents have all demonstrated some benefit in the treatment of PTSD.

  3. Unknown benefit: second generation antipsychotics, buspirone, hypnotics (zolpidem), trazodone, gabapentin, lamotrigine, propranolol, clonidine

  4. Thought to have no benefit or cause harm: benzodiazepines, valproic acid, tiagabine, guanfacine, topiramate

The American Psychiatric Association – Guideline Watch Update, 20092

  1. SSRIs/SNRIs are supported for non-combat related PTSD

  2. Called under question for combat-related PTSD (perhaps still recommended though with a lower level of confidence as non-combat related PTSD)

  3. Efficacy of beta-blocker (propranolol studied) to prevent PTSD after a trauma questioned as little difference shown compared to placebo

  4. Prazosin, an α-adrenergic antagonist, shows most promising evidence for treatment of PTSD-related nightmares

  5. Data for adjunctive treatment with second generation antipsychotics “encouraging”

  6. Anticonvulsants are not recommended adjunctively or otherwise at this time

International Society for Traumatic Stress Studies (ISTSS) —updated 20083

  1. Best evidence is for SSRIs (sertraline, paroxetine, fluoxetine) & SNRIs (venlafaxine)

  2. Also included are TCAs, mirtazapine, nefazodone, MAOIs (phenelzine)

  3. Prazosin given a high rating for efficacy with regard to PTSD nightmares

  4. Second line treatment: consider bupropion or trazodone

National Health and Medical Research Council – updated 20074

  1. SSRIs are recommended as first line pharmacotherapy

  2. Second line antidepressants to be considered are mirtazapine or TCAs

National Institute for Health and Clinical Excellence (NICE), United Kingdom –updated, 2005 5

  1. Medications are not first line, preference to trauma-focused psychological therapy

  2. Consider paroxetine or mirtazapine (either as adjunct to psychotherapy or refusal/failure of psychotherapy)

  3. Consider amitriptyline or phenelzine if above options fail/not tolerated

  4. Continue for 12 months after response to medication

  5. For non-response, consider antidepressant with adjunctive olanzapine

International Consensus Group on Depression and Anxiety-updated 2004 6

  1. SSRIs are supported by evidence; should be implemented along with psychotherapy within 3 to 4 weeks of PTSD symptomatology

  2. Benzodiazepines are not effective

  • Download PDF
Copyright: © 2013 College of Psychiatric and Neurologic Pharmacists