Evidence Base for Pharmacological Treatments for PTSD in Noncancer Patientsa,b
| Medication | Dosing (mg/day) | Target Symptomsc | Evidence Basis |
| Selective Serotonin Reuptake Inhibitors (SSRIs)d | |||
| Sertralinee | 50–200 | All symptom clusters | Several RCTs |
| Paroxetinee | 20–50 | All symptom clusters | Several RCTs |
| Fluoxetine | 20–60 | All symptom clusters | Several RCTs |
| Fluvoxamine | 50–300 | All symptom clusters | Open label |
| Citalopram | 20–60 | All symptom clusters | Open label |
| Serotonin-potentiating Non-SSRIs | |||
| Venlafaxine | 37.5–225 | All symptom clusters | Open label |
| Trazodone | 50–300 | Insomnia, possibly other clusters | Open label |
| Mirtazapine | 15–45 | Insomnia, possibly other clusters | Open label |
| Other Antidepressants | |||
| Imipramine | 50–225 | Possibly all clusters | One RCT |
| Other Agents Used as Augmentation Therapy Onlyf | |||
| Atypical antipsychotics | |||
| Risperidone | 1–6 | Clusters B and D, possibly cluster C | Several RCTs |
| Olanzapine | 5–20 | Possibly all clusters | One RCT |
| Anticonvulsants | |||
| Lamotrigine | 50–400 | Clusters B and C | One RCT |
| Adrenergic-inhibiting agents | |||
| Prazosin | 2–6 | All symptom clusters (primary target symptom: nightmares) | Several RCTs |
| RCT = randomized controlled trial. | |||
| aAdapted from Berger et al.[10] and Asnis et al.[11] | |||
| bAll studies conducted in noncancer patients only. No studies conducted in patients with cancer. | |||
| cPTSD symptom clusters are as follows: cluster B, re-experiencing; cluster C, avoidance/numbing; cluster D, hyperarousal. | |||
| dConsidered first-line treatments for PTSD. | |||
| eFDA approved for the treatment of PTSD. | |||
| fUsed mainly as augmentation to SSRIs or serotonin-potentiating non-SSRIs. |
References
- Berger W, Mendlowicz MV, Marques-Portella C, et al.: Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry 33 (2): 169-80, 2009. [PUBMED Abstract]
- Asnis GM, Kohn SR, Henderson M, et al.: SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs 64 (4): 383-404, 2004. [PUBMED Abstract]
