PTSD - Psychopharmacotherapy for Adults

Psychopharmacotherapy for Adults. There is a strong rationale for pharmacotherapy as an important treatment in posttraumatic stress disorder (PTSD). There is considerable overlap between symptoms of PTSD, depression, and other anxiety disorders. Finally, PTSD is frequently comorbid with psychiatric disorders that are responsive to pharmacological treatment. Medication treatment is one of the most feasible treatments for (PTSD). Most studies involve selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and other serotoner gic agents (trazodone and nefazodone). Antiadrenergic drugs tested include the alpha-1 receptor (prazosin), the alpha-2 receptor agonists (clonidine and guanfacine) and the beta receptor antagonist (propranolol). Recent developments include tests of mood-stabilizing anticonvulsants and augmentation strategies with atypical antipsychotics for SSRI partial responders. The best evidence supports the use of SSRIs and SNRIs as first-line drugs for PTSD. There is also good evidence that augmentation with atypical antipsychotic agents is effective. Recent results with prazosin and mirtazapine are also promising. MAOIs are moderately effective and TCAs are mildly effective agents, although both may produce adverse side effects. Evidence supporting the use of anticonvulsants is weak, not because of negative findings, but because there have been so few randomized trials with either class of drugs. There is good evidence to suggest that benzodiazepines are not useful in treating PTSD. Finally, there is reason to believe that new, as yet untested, pharmacological agents that work through different mechanisms of action may prove to be more effective than medications that are currently available. Suggested Readings Effective Treatments for PTSD - Practice Guidelines from the International Society for Traumatic Stress Studies - edited by Edna B. Foa, Terence M. Keane, Matthew J. Friedman Judith A. Cohen Davidson, J., Bernik, M., Connor, K. M., Friedman, M. J., Jobson, K. O., Kim, Y., et al. (2005). A new treatment algorithm for posttraumatic stress disorder. Psychiatric Annals, 35, 887900. Friedman, M. J., & Davidson, J. R. T. (2007). Pharmacotherapy for PTSD. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 376405). New York: Guilford Press.