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Post-traumatic stress disorder: treatment
Last reviewed: 23.04.2024
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As with other anxiety disorders, a thorough psychiatric, somatic and neurological examination of the patient is essential to the success of PTSD, as several clinical factors are of particular importance in the choice of treatment. First, in patients with a trauma, somatic or neurological disorders are often observed. Some of them appear immediately after the injury (for example, organic brain damage), others - delayed (eg, withdrawal syndromes in patients abusing psychotropic substances). Patients often experience an injury again. Therefore, when planning treatment, you need to assess the risk of re-trauma and take steps to avoid it.
Although a number of drugs were tested with GGGSR, only about ten of them published the results of randomized clinical trials. Currently, there is no conclusive evidence of the benefits of any one drug over the others. However, moderate efficacy of such drugs as fluoxetine, phenelzine, alprazolam, amitriptyline, imipramine and desipramine has been noted. At the same time, there is no clear data on the characteristics of the action of a given drug in the GGGSR. Nevertheless, there are reports of higher efficacy of fluoxetine in victims of non-military injuries; At the same time, phenelzin is probably the most studied treatment for GGGSR, it more effectively affects the symptoms of an obsessive nature than the manifestations of increased excitability. Alprazolam helps to reduce anxiety, which is the main component of GGGSR, but has little effect on other manifestations of the disorder. Trials of tricyclic antidepressants with GGGSR have produced mixed results. The dosage regimen of these drugs with PTSD is the same as in panic disorder, however, some patients with PTSD tolerate and increase the dose more quickly.
Since the results of studies on the effectiveness of drugs in PTSD have been mixed, the choice of PTSD therapy is largely based on the principles tested in the treatment of other anxiety disorders. The means of choice in the treatment of PTSD can be considered SSRIs, given their safety, the breadth of the therapeutic window, high efficiency in relation to various comorbid conditions, low risk of dependence. At the same time, the use of benzodiazepines is associated with significant problems, mainly because of the high risk of developing drug dependence, since many patients with PTSD are dependent on psychotropic drugs. Benzodiazepines are most useful in those cases when it is required to quickly arrest intense anxiety. 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 agents of beta-blockers, anticonvulsants, alpha-adrenergic agonists) was evaluated only in open trials. Although some evidence has been obtained that these drugs reduce individual symptoms of PTSD, they should be treated with caution until the results of controlled clinical trials are obtained. As with social phobia, the effectiveness of combination therapy in PTSD was not evaluated in controlled clinical trials. Nevertheless, attempts are being made to use combinations with PTSD, tested with social phobia and panic disorder (for example, a combination of benzodiazepine with SSRIs or a tricyclic antidepressant).
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