Medication can be taken for the following purposes: Temporary relief of severe symptoms such as insomnia or panic attacks Long-term relief of PTSD symptoms Antidepressants, sleeping pills and sedatives (benzodiazepines) are the most commonly used medications in the treatment of PTSD.
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How do medications for PTSD work?
The medications prescribed for treating PTSD symptoms broadly act upon neurotransmitters affecting the fear and anxiety circuitry of the brain including serotonin, norepinephrine, gamma-aminobutyric acid (GABA), the excitatory amino acid glutamate, and dopamine, among many others.
Should we question the evidence supporting medications being prescribed for PTSD?
It is vital to question the level of evidence supporting the medications being prescribed for PTSD when making treatment recommendations, because there are a variety of influences on prescribing, including marketing, patient preferences and clinical custom, all of which can be inconsistent with the current scientific evidence.
Can pharmacotherapy prevent PTSD in physically injured patients?
Pharmacotherapy to prevent PTSD: results from a randomized controlled proof-of-consept trial in physically injured patients. J Trauma Stress. 2007;20:923– 932.
What is the first-line treatment for PTSD?
Matt Jeffreys, MD The 2017 VA/DoD Clinical Practice Guideline for PTSD recommends trauma-focused psychotherapy as the first-line treatment for PTSD over pharmacotherapy (1). For patients who prefer pharmacotherapy or who do not have access to trauma-focused psychotherapy, medications remain a treatment option.
Which medications are primarily used for the treatment of PTSD?
The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
What are the most effective treatments for PTSD?
The gold standard for treating PTSD symptoms is psychotherapy, particularly cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy. EMDR and EFT have also shown promise in helping people recover from PTSD.
How effective is medication for PTSD?
Although SSRIs are associated with an overall response rate of approximately 60% in patients with PTSD, only 20% to 30% of patients achieve complete remission.
What is the goal of PTSD treatment?
There are three main goals for PTSD treatment: Ease the PTSD symptoms, making them less frequent and less intrusive or impactful on your life. Teach you how to manage the symptoms when they do occur. Restore a positive sense of self, your self-esteem.
How can PTSD be treated?
While each case of PTSD has unique biological, psychological and social determinants with differing treatment implications, there are empirically supported treatments that can reduce or alleviate symptoms. Medications can be used to ameliorate the biological basis for PTSD symptoms along with co-occurring psychiatric diagnoses, and indirectly may benefit psychological and social symptoms as well. Studies suggest that cognitive behavioral therapies (CBT) such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) have greater effects on relieving PTSD symptoms than medications (2), but there have been few head-to-head comparisons, and there remain many unanswered questions regarding the role of pharmacotherapy.
What is the best medication for PTSD?
Evidence for PTSD pharmacology is strongest for specific selective serotonin reuptake inhibitors (SSRIs)—sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac)—and a particular serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine (Effexor) (1). Currently, only sertraline and paroxetine are approved by the Food and Drug Administration (FDA) for PTSD (3,4). From the FDA perspective, all other medication uses are off label, though there are differing levels of evidence supporting their use. The 2017 VA/DoD Clinical Practice Guideline for PTSD further offers weak recommendation for, or suggests, other antidepressants for PTSD treatment if the four strongly recommended medications are ineffective, unavailable, or not tolerated. They are the serotonin potentiator, nefazodone (Serzone); the tricyclic antidepressant, imipramine (Tofranil); and the mono-amine oxidase inhibitor, phenelzine (Nardil). Both nefazodone and phenelzine require careful management as they carry potentially serious toxicities (1).
What is treatment planning?
Treatment planning is a collaborative effort between the clinician and the individual. Clinicians recognize the need to tailor pharmacotherapy to the needs of the individual patient. For example:
What is D-cycloserine used for?
D-cycloserine (DCS) has been used in panic disorder, specific phobia, obsessive-compulsive disorder, and social anxiety disorder, to enhance the effects of exposure therapy (61). It is a partial agonist of the glutamatergic N-methyl-D-aspartate (NMDA) receptor.
Can divalproex be used for bipolar disorder?
Some of these medications are definitely indicated for bipolar disorder whether or not it is comorbid with PTSD and require close monitoring for side effects. Divalproex and carbamazepine require regular lab work to monitor side effects, but neither lamotrigine nor topiramate require lab work but must be titrated slowly according to package insert directions to avoid potentially serious side effects. Examples are given below:
Is trauma focused psychotherapy the first line of treatment for PTSD?
The 2017 VA/DoD Clinical Practice Guideline for PTSD recommends trauma-focused psychotherapy as the first-line treatment for PTSD over pharmaco therapy (1). For patients who prefer pharmacotherapy or who do not have access to trauma-focused psychotherapy, medications remain a treatment option. PTSD also carries high levels of psychiatric comorbidities which may be treated with medications.
Is sertraline approved for PTSD?
Currently, only sertraline and paroxetine are approved by the Food and Drug Administration (FDA) for PTSD (3,4). From the FDA perspective, all other medication uses are off label, though there are differing levels of evidence supporting their use.
What is the best medication for PTSD?
Medications for PTSD. The medications conditionally recommended for the treatment of PTSD are sertraline, paroxetine, fluoxetine and venlafaxine. Each patient varies in their response and ability to tolerate a specific medication and dosage, so medications must be tailored to individual needs.
Which SSRIs are best for PTSD?
The current evidence base for PTSD psychopharmacology is strongest for the selective serotonin reuptake inhibitors (SSRIs): sertraline, paroxetine and fluoxetine as well as the selective serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine.
What is selective serotonin reuptake inhibitor?
Selective Serotonin Reuptake Inhibitors. The neurotransmitter serotonin has a well-recognized role in the experience of mood and anxiety disorders. The activity of this neurotransmitter in both the peripheral and central nervous systems can be modulated by SSRIs. The SSRIs sertraline and paroxetine are the only medications approved by ...
What is the best way to choose treatment?
Choice of treatment should be based on the best scientific evidence, comfort with the options, and consultation with a physician, psychologist or mental health professional.
Does topiramate help with PTSD?
Topiramate is in the anti-epileptic category of medications and is thought to modulate glutamate neurotransmission . There has been recent interest in its use for PTSD. The systematic review that served as the evidence base for the guideline development panel reported moderate strength of evidence for a medium to large magnitude effect for PTSD symptom reduction.
Is topiramate better than SSRI?
However, the panel concluded that there was insufficient evidence to make a recommendation because the potential side effects/harms for topiramate are greater than they are for SSRI antidepressants. It is not uncommon for patients taking topiramate to note side effects of cognitive dulling. Topiramate has also been found helpful in reducing alcohol consumption in those with an alcohol use disorder, which frequently accompanies PTSD.
Is Zoloft approved for PTSD?
Currently only sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD. From the FDA perspective, all other medication uses are “off label” (see footnote), though there are differing levels of evidence supporting their use.
What is the best treatment for PTSD?
Psychotherapy. Some forms of psychotherapy — also known as talk therapy — are effective treatments for PTSD. Most of them are based on cognitive behavioral therapy (CBT), a kind of talk therapy that aims to identify and correct unhealthy and unrealistic thought patterns.
How to reduce symptoms of PTSD?
Research has shown that writing about the traumatic event in several short sessions may help reduce symptoms of PTSD significantly.
How to change fear response?
To change your fear response, prolonged exposure therapy begins with some education about PTSD symptoms. Your therapist will equip you with skills to calm down and cope when you face something frightening. Once you’ve learned self-calming techniques, you and your therapist will create a hierarchy of fears.
How to get help for PTSD?
The National Center for PTSD provides a number of resources, including: 1 apps such as the PTSD Coach, PTSD Family Coach, Insomnia Coach, and Mindfulness Coach 2 video tutorials that can educate you in greater depth about symptoms and treatments 3 PTSD Treatment Decision Aid to help you decide which options suit your needs best 4 online programs to help you deal with stress, anger, parenting challenges, and sleep issues
What are the benefits of PTSD therapy?
Some potential benefits of therapy can include: reduced anxiety. reduction of depression symptoms. decreasing the chance of relapse of depression symptoms. improving skills needed for daily activities.
How many sessions are there in CPT?
CPT aims to identify those incorrect conclusions and restructure them in healthier ways. This kind of therapy usually takes place in around 12 sessions, during which you and your therapist work together to process what happened through talking or writing about the experience.
Why is it so hard to recover from trauma?
What works for one person may not help someone else at all. This is because people respond to trauma differently, and the effects of trauma can be complicated. When you experience a traumatic event, your hypothalamic, pituitary, and adrenal systems release a surge ...
How many medications are conditionally recommended for PTSD?
Three psychotherapies and four medications are conditionally recommended. Interventions that received a conditional recommendation all have evidence that indicates that they can lead to good treatment outcomes; however, the evidence may not be as strong, or the balance of treatment benefits and possible harms may be less favorable, or the intervention may be less applicable across treatment settings or subgroups of individuals with PTSD. Additional research may lead to a change in the strength of recommendations in future guidelines.
What is the information below about the recommended interventions?
The information below about the recommended interventions is intended to provide clinicians with a basic understanding of the specific treatment approach. Clinicians are encouraged to become familiar with each of the different interventions to determine which of these might be consistent with their practice, to develop a plan for additional training and professional development, and to become informed about the range of evidence-based treatment options in order to help patients with decision making and any necessary referrals. The information contained herein is not sufficient to enable one to become proficient in delivering these treatments. Clinicians are encouraged to pursue training opportunities and, to become fully competent in new interventions, receive consultation or supervision while first delivering the intervention.
What is CBT therapy?
The category of CBT encompasses various types and elements of treatment used by cognitive behavioral therapists, while Cognitive Processing Therapy, Cognitive Therapy and Prolonged Exposure are all more specialized treatments that focus on particular aspects of CBT interventions.
How many sessions are there in cognitive behavioral therapy?
For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. It is typically delivered over 12-16 sessions in either individual or group format.
What is brief eclectic therapy?
Brief eclectic psychotherapy combines elements of cognitive behavioral therapy with a psychodynamic approach. It focuses on changing the emotions of shame and guilt and emphasizes the relationship between the patient and therapist.
What is cognitive therapy?
Derived from cognitive behavioral therapy, cognitive therapy entails modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral and/or thought patterns that have been interfering in the person’s daily life.
What is cognitive behavioral therapy?
Cognitive behavioral therapy focuses on the relationships among thoughts, feelings and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.
What is the FDA approved medication for PTSD?
These two medications are selective serotonin-reuptake inhibitors (SSRIs) sertraline (Zoloft) and paroxetine (Paxil). Both of these medications are antidepressants ...
What is the best medication for PTSD?
If none of the above PTSD medications are effective, the medications with the next-greatest scientific evidence support are: 1 Mirtazapine (Remeron) – an alpha-2 antagonist antidepressant 2 Nefazodone (Serzone) – an SSRI antidepressant (no longer available) 3 Tricyclic antidepressants (TCAs) such as amitriptyline (Elavil) or imipramine (Tofranil) 4 Phenelzine (Nardil) – a monoamine oxidase inhibitor (MAOI) antidepressant
How long does it take to respond to PTSD medication?
In order to get the best results, before trying an augmentation strategy (adding an additional medication), the VA recommends maximizing the dosage and allowing at least eight weeks for the person to respond to the PTSD drug. For those with partial response, another four weeks is recommended.
Is marijuana good for PTSD?
While there are anecdotes suggesting that some with PTSD may find medical marijuana helpful, this has not been bor ne out in studies. Not only has medical marijuana for PTSD not been shown effective, but it has actually been shown to be harmful. For more information, please see Marijuana and PTSD: Is It Helpful or Hurtful?
Can benzodiazepines be used for PTSD?
The VA also notes that not only are benzodiazepines not indicated for PTSD, but there is actually evidence against their use .
Can you take PTSD medication?
If you have posttraumatic stress disorder (PTSD), you may be considering PTSD medication (sometimes known as “meds” for PTSD). This is often a big decision, but many medications are used to help treat PTSD. The question remains, though, what medications are effective in treating PTSD and how effective are PTSD medications?
What medications are prescribed for PTSD?
Because people respond differently to medications, and not everyone's PTSD is the same, your doctor may prescribe other medicines "off label," too. (That means the manufacturer didn't ask the FDA to review studies of the drug showing that it's effective specifically for PTSD.) These may include: 1 Antidepressants 2 Monoamine oxidase inhibitors (MAOIs) 3 Antipsychotics or second generation antipsychotics (SGAs) 4 Beta-blockers 5 Benzodiazepines
How to help someone with PTSD?
Improve your symptoms. Teach you skills to deal with it. Restore your self-esteem. Most PTSD therapies fall under the umbrella of cognitive behavioral therapy (CBT). The idea is to change the thought patterns that are disturbing your life.
What medications affect serotonin?
Doctors will usually start with medications that affect the neurotransmitters serotonin or norepinephrine (SSRIs and SNRIs), including: Fluoxetine ( Prozac) Paroxetine (Paxil) Sertraline ( Zoloft) Venlafaxine (Effexor) The FDA has approved only paroxetine and sertraline for treating PTSD.
Why do people with PTSD have a fight or flight response?
The brains of people with PTSD process "threats" differently, in part because the balance of chemicals called neurotransmitters is out of whack. They have an easily triggered "fight or flight" response, which is what makes you jumpy and on-edge.
What is PTSD in 2020?
Medically Reviewed by Smitha Bhandari, MD on January 21, 2020. Posttraumatic stress disorder (PTSD), a type of anxiety disorder, can happen after a deeply threatening or scary event. Even if you weren't directly involved, the shock of what happened can be so great that you have a hard time living a normal life.
Why do doctors prescribe off label medications?
Because people respond differently to medications, and not everyone's PTSD is the same , your doctor may prescribe other medicines "off label," too. (That means the manufacturer didn't ask the FDA to review studies of the drug showing that it's effective specifically for PTSD.) These may include:
What does a therapist do when you are blaming yourself?
Your therapist will help you take into account all the things that were beyond your control, so you can move forward, understanding and accepting that, deep down, it wasn't your fault, despite things you did or didn't do.
How do I treat PTSD?
Preventive treatment starts prior to symptom development. Symptomatic or preventive approaches raise different ethical and socioeconomic concerns: only a subpopulation of those experiencing a traumatic event will also develop PTSD and indiscriminate treatment should be avoided. Therefore, it would be useful for preventive treatment to be effective to distinguish subjects that are at risk to develop PTSD from those that are not. However, although a number of such markers have been proposed, e.g., lower cortisol levels, increased heart rate dynamics shortly after the traumatic event or increased circulating PACAP (Yehuda, 2004; O’Donnell et al. 2007; Ressler et al. 2011) or other vulnerability factors, such as polymorphism of the 5-HT transporter (see above) or of FkBP5, a co-chaperone that modulates the glucocorticoid receptor (GR) (Binder et al. 2008), none qualify so far as a prognostic tool with sufficiently high accuracy. Another complicating factor of preventive pharmacological approaches is the need of such treatment to effectively counteract the development of PTSD symptoms, while leaving normal function undisturbed, i.e., the normal psychological responses to traumatic events, including cognitive and psychomotor function, should remain unimpaired.
What are the systems involved in PTSD?
A number of interrelated neurochemical systems have been suggested to be involved in the mediation of stress responsivity, formation of traumatic memories and the pathophysiology of PTSD, including glutamate, GABA, CRF and noradrenaline , amongst others. Evidently, there are strong interactions between these systems, giving rise to different therapeutic approaches that could be useful to prevent the development of PTSD. Acute stress exposure, for example, which may mimic the acute traumatic event leading to PTSD, induces increases in glutamate transmission across multiple systems: PFC, amygdala, BNST, hippocampus and noradrenergic locus coeruleus (LC) in rats (Gilad et al., 1990; Moghaddam, 1993; Reznikov et al., 2007; Walker and Davis, 2008). It has been suggested that insufficient top-down control of these circuits from the PFC could lead to stress hyperreactivity. Poor PFC control of the LC could lead to hyperreactivity of the noradrenergic projection from the LC to the basolateral amygdala (BLA), while poor PFC control of the PVN could lead to increased CRF and downstream glucocorticoid signalling (Hurlemann, 2008; Hurlemann et al., 2007). These systems often act in a reciprocal fashion, with altered glucocorticoid signalling in turn affecting acute glutamatergic neurotransmission in cortico-limbic circuits (Moghaddam et al., 1994). There is also evidence for reciprocal modulation across CRF and NE systems, with increased NE driving increased CRF release and vice versa (Gresack and Risbrough, 2010; Dunn et al. 2004). Thus, there are strong interactions between the different neuroanatomical and chemical systems that have been implicated in PTSD and pharmacological manipulations of the glutamatergic or GABAergic systems, the CRF system, the noradrenergic system, or normalization of HPA axis activity by other means could be of utility in the treatment of PTSD, directly or indirectly affecting the different neurochemical systems involved.
How does PTSD affect people?
Symptoms should persist for a minimum of four weeks before a diagnosis is made. PTSD affects a subpopulation (10–15%) of people exposed to traumatic events, with a lifetime prevalence of 6.8% in the US (Kessler et al., 2005).
Which monoaminergic system is linked to PTSD?
Another monoaminergic system linked to PTSD is the serotonergic (5-HT) system (e.g., Krystal and Neumeister, 2009). Polymorphism of the 5-HT transporter (the 5-HTTLPR genotype), in interaction with adult traumatic events and childhood adversity, has been reported to be a susceptibility factor for PTSD (Lee et al., 2005; Grabe et al., 2009; Xie et al., 2009). Furthermore, stress has been reported to increase 5-HT neurotransmission in several forebrain regions, including frontal cortex, hippocampus and amygdala (Linthorst, 2005). Selective serotonin re-uptake inhibitors (SSRIs) are also efficacious in treating the disorder at least in some individuals, suggestive that 5-HT could play a role in the pathogenesis of the disorder (Bandelow et al., 2008).
Do psychoactive drugs help with PTSD?
Thus, although there is evidence that pharmacological approaches using psychoactive drugs that are currently in the clinic have some beneficial effects in PTSD, with the most convincing data generated for antidepressant drugs, this evidence must be considered mixed. Almost all of the drug classes examined for efficacy in PTSD suffer from a dearth of adequately powered studies to support definitive conclusions either for or against efficacy. Along these lines, the Committee on Treatment of Posttraumatic Stress Disorder (2008)concluded that for all the drug classes mentioned above, the evidence is inadequate to determine efficacy in the treatment of PTSD. Overall the field clearly requires more efficacious pharmacological approaches to treat this disorder, as well as a more concentrated effort to adequately test potential therapeutics in large randomized clinical trials (Leon and Davis, 2009).
Is GR a dose dependent effect?
Thus, the net effect of direct or indirect GR manipulations seems to be dose-dependent and outcome of such manipulations in PTSD patients may depend on exposure achieved at the GR. It will be difficult to predict this response at the individual level as cortisol efficacy may depend on individual differences in cortisol responses to stress and in expression of genes modulating GR signalling (e.g. FKBP5, see Mehta and Binder, in press, this issue). In sum, there seems to be an inherent risk that interventions that inhibit GR signalling, either directly or indirectly, could actually facilitate the development of PTSD. Clearly more studies are required to delineate the complex role of GR signalling effects during and after trauma to develop appropriate prophylactic treatments targeted at this system.
Does cortisol affect PTSD?
These low cortisol levels have been suggested to play a role in re-experiencing of the traumatic event as they may facilitate retrieval of the aversive memories (De Quervain et al., 2009; but see Baker et al., 2005, reporting elevated CSF cortisol levels in PTSD patients despite normal plasma and urinary cortisol levels, suggesting that plasma cortisol is not representative of central cortisol level). At the same time, it seems that there is a greater reactivity of the HPA axis to stressors, which renders the HPA axis maximally responsive to stress-related cues in PTSD (Yehuda, 2005), potentially facilitating re-consolidation of the aversive memories (Taubenfeld et al. 2009).
Psychotherapy in Combat PTSD Treatment
Psychotherapy is the most common form of combat-related PTSD treatment and is appropriate for everyone seeking treatment. Veterans often worry that this will mean sitting around talking about their childhood, but the most common types of psychotherapy for combat PTSD focus on skill building and dealing with the specific trauma.
Medication in Combat PTSD Treatment
Medication is appropriate in some cases of combat-related PTSD but it is almost always combined with psychotherapy for the best outcome. It is most often used in severe cases of combat PTSD or in cases where the PTSD manifests in significant physiological symptoms, such as depression and anxiety.
Medication vs. Psychotherapy in Combat PTSD Treatment
The selection of medication and type of psychotherapy in combat PTSD treatment must be specific to the individual. What’s important to remember about combat PTSD treatment is that there are a variety of options and if one doesn’t work, there are many more to try.