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4 pharmacological treatments of PTSD 

This article summarises possible pharmacological treatments that may be considered in the management of PTSD.
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Pharmacological medications form an important part of the management of many mental health problems, including PTSD. Pharmacological treatment may be a key component of an individual’s care plan, and are frequently used in combination with other treatments, including psychological interventions, recreational therapies, rehabilitation approaches, and occupational therapies. Choice of medication depends on the individual. The coexistence of physical health problems such as diabetes, epilepsy, or heart disease and known side effects of specific medications which need to be carefully considered. Medication decisions should be made collaboratively using an evidence-based but patient-centred approach.

1. Anti-Depressants

Anti-depressants are one of the most commonly prescribed medications to treat PTSD. The main anti-depressant classes that can be used to treat PTSD include:

Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs tend to be the first prescription option for PTSD as they are safe, effective and well-tolerated.
Examples: Sertraline, Paroxetine.
Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) SNRIs can be used to treat PTSD.
Example: Venlafaxine.
Noradrenergic and Specific Serotonin Antidepressants (NaSSa) NaSSa’s tends to be used in people who fail to respond to SSRIs and have significant sleep disturbance.
Example: Mirtazapine.
Tri-Cyclic Antidepressants (TCAs) TCAs tend to have more side effects and are dangerous if taken as an overdose. They tend to be used second-line after SSRIs and NaSSa’s.
Example: Amitriptyline
Mono-Amine Oxidase Inhibitors (MAOIs) MAOIs have certain diet restrictions such as the avoidance of Tyramine contained in foods including Bovril, Marmite, tofu, and game. MAOIs tend to be used after SSRIs, NaSSa and TCAs.
Example: Phenelzine.

2. Prazosin

Prazosin can be used to treat the nightmares associated with PTSD. It can be used alone or in combination with anti-depressant therapy. Prazosin is an alpha-blocker and can affect blood pressure. Therefore this medication is usually only prescribed by specialist mental health teams.

3. Anti-Psychotic Medication

In some cases of severe PTSD, an antipsychotic medication such as Risperidone may be considered. This is usually prescribed for individuals with highly distressing symptoms who have not responded to other pharmacological management strategies. Anti-psychotic medication is usually prescribed in combination with psychological therapies.

4. Benzodiazepines

The use of routine benzodiazepines after a traumatic event is not recommended to prevent PTSD.

References

NICE. (2018). Recommendations | Post-traumatic stress disorder | Guidance | NICE. Retrieved from https://www.nice.org.uk/guidance/ng116

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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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