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What medications are used? As of December 2001, two medications are approved for treating PTSD by the U.S. Food and Drug Administration (FDA), sertraline (Zoloft) and paroxetine (Paxil), selective serotonin reuptake inhibitors (SSRIs). FDA approval is based on multi-center double-blind studies. Read an abstract of a paroxetine study, "Efficacy and Safety of Paroxetine Treatment for Chronic PTSD: A Fixed- Dose, Placebo-Controlled Study," American Journal of Psychiatry (2001)158:1982-1988. For information about a recent study showing sertraline's effectiveness, "Efficacy and Safety of Sertraline Treatment of Posttraumatic Stress Disorder: a randomized control trial," JAMA (2000)283:1837-1844, click here. In addition to proven effectiveness, selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication treatment for PTSD because their side effects are fewer and less troubling. The Expert Consensus Guidelines also saw promise in two comparatively new antidepressants: nefazodone (Serzone) and venlafaxine (Effexor) as second-line treatment if SSRIs prove ineffective or are not well tolerated. They have a more favorable side-effect profile than the tricyclics. Tricyclic antidepressants (TCAs) 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. Mood stabilizers may be added to improve a partial response to an antidepressant. Anti-anxiety medications medications (anxiolytics) including benzodiazepines 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. 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) may be a helpful adjunctive treatment for anxiety symptoms in people with PTSD, although evidence for its effectiveness is limited. In addition, a class of medications called monoamine oxidase inhibitors (MAOIs) has also been shown to be helpful in PTSD. However, MAOIs are rarely used because of more frequent side effects than found with SSRIs and because a careful diet must be followed to prevent dangerous increases in blood pressure. Hear from Dr. Jonathan Davidson on PTSD medications. If a medication is well tolerated, most patients will continue to take it for 6 to 12 months if they have acute PTSD (less than 3 months duration) and for at least 12 and as long as 24 months for chronic PTSD before trying to taper off the medication. If PTSD symptoms return when medication is being discontinued, the effective dose would be resumed and usually continued for an even longer time before discontinuation is tried again.
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