Are There Effective Psychopharmacologic Treatments for PTSD?
Published Dec 18, 2018 · Teddy J. Akiki, C. Abdallah
The Journal of clinical psychiatry
34
Citations
1
Influential Citations
Abstract
Posttraumatic stress disorder (PTSD) is a common and debilitating condition that develops in certain individuals after exposure to traumatic events, with a lifetime prevalence of 6.4% in the United States.1 PTSD is typically characterized by a chronic and often severe time course, with a substantial symptom burden and rate of disability.1 PTSD symptomatology is multifaceted, with symptom dimensions that include re-experiencing, avoidance of trauma-related stimuli, negative thoughts and feelings, and arousal and reactivity. Further, PTSD co-occurs with other psychiatric disorders more often than not (eg, depression, anxiety, and substance use).1 Despite notable recent advances, the pathophysiology of PTSD remains poorly understood, but it is thought to involve dysfunction in multiple biological systems, including synaptic dysregulation/neurocircuitry, neuroendocrine, neurotransmitter, and inflammatory.2–4 Despite this dire need for effective treatments, only 2 medications are currently approved by the US Food and Drug Administration (FDA) for the treatment of PTSD: paroxetine and sertraline—both belonging to the same class of selective serotonin reuptake inhibitors (SSRIs).5 Polypharmacy and off-label prescriptions are common in PTSD, likely driven by the suboptimal response to treatment and the high prevalence of psychiatric comorbidities.6 In this brief article, we review commonly used pharmacologic interventions and summarize the evidence supporting each. We also review investigational agents that have shown promise in translating to clinical practice. A comprehensive review of pharmacotherapy is beyond the scope of this focused report; for systematic reviews, we suggest refs.5,7,8