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Post-traumatic Stress Disorder (PDQ®)

  • Updated: 09/03/2014

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
Sertralinee50–200All symptom clustersSeveral RCTs
Paroxetinee20–50All symptom clustersSeveral RCTs
Fluoxetine20–60All symptom clustersSeveral RCTs
Fluvoxamine50–300All symptom clustersOpen label
Citalopram20–60All symptom clustersOpen label
Serotonin-potentiating Non-SSRIs
Venlafaxine37.5–225All symptom clustersOpen label
Trazodone50–300Insomnia, possibly other clustersOpen label
Mirtazapine15–45Insomnia, possibly other clustersOpen label
Other Antidepressants
Imipramine50–225Possibly all clustersOne RCT
Other Agents Used as Augmentation Therapy Onlyf
Atypical antipsychotics
Risperidone1–6Clusters B and D, possibly cluster CSeveral RCTs
Olanzapine5–20Possibly all clustersOne RCT
Anticonvulsants
Lamotrigine50–400Clusters B and COne RCT
Adrenergic-inhibiting agents
Prazosin2–6All 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

  1. 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]

  2. 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]