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Post Traumatic Stress Disorder - Treatment
Last reviewed: 06.07.2025
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As with other anxiety disorders, the key to successful treatment of PTSD is a thorough psychiatric, somatic, and neurological examination of the patient, since several clinical factors are particularly important in choosing treatment. First, patients who have experienced trauma often have somatic or neurological disorders. Some of these appear immediately after the trauma (e.g., organic brain damage), while others appear later (e.g., withdrawal symptoms in patients who abuse psychotropic substances). Patients often experience repeated trauma. Therefore, when planning treatment, it is necessary to assess the risk of repeated trauma and take measures to avoid it.
Although a number of drugs have been tested in HTHD, only about ten have published randomized controlled trials. There is no convincing evidence that any one drug is superior to others. However, fluoxetine, phenelzine, alprazolam, amitriptyline, imipramine, and desipramine have been shown to be moderately effective. However, there is no clear evidence for the specific effects of any drug in HTHD. However, fluoxetine has been reported to be more effective in non-combat trauma victims; while phenelzine, perhaps the best-studied treatment for HTHD, is more effective in reducing obsessive-compulsive symptoms than in reducing hyperarousal symptoms. Alprazolam reduces anxiety, a major component of HTHD, but has little effect on other aspects of the disorder. Trials of tricyclic antidepressants in HTHD have yielded mixed results. The dosing regimen for these medications for PTSD is the same as for panic disorder, but some PTSD patients tolerate a more rapid increase in dose well.
Since the results of studies on the effectiveness of drugs in PTSD have been ambiguous, the choice of PTSD therapy is largely based on the principles tested in the treatment of other anxiety disorders. SSRIs can be considered the drug of choice in the treatment of PTSD, given their safety, wide therapeutic window, high effectiveness in relation to various comorbid conditions, and low risk of addiction. At the same time, the use of benzodiazepines is associated with significant problems, mainly due to the high risk of drug addiction, since many patients with PTSD are dependent on psychotropic drugs. Benzodiazepines are most useful in cases where rapid relief of intense anxiety is required. Tricyclic antidepressants and MAO inhibitors, given their side effects and the risk of intoxication, are prescribed only if SSRIs are ineffective. The effectiveness of other drugs (beta-blockers, anticonvulsants, alpha-adrenergic agonists) has been assessed only in open studies. Although there is some evidence that these drugs reduce individual symptoms of PTSD, they should be used with caution until the results of controlled clinical trials are available. As with social phobia, the effectiveness of combination therapy in PTSD has not been evaluated in controlled clinical trials. However, attempts are being made to use combinations tested in social phobia and panic disorder in PTSD (eg, combinations of a benzodiazepine with an SSRI or tricyclic antidepressant).
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