Medication treatment of post-traumatic stress helps with the most acute symptoms. However, medications should not be offered as an alternative to psychotherapy. Globally, psychotherapy is a more effective means of treating PTSD than medication. Therefore, it is recommended that the prescribed medication be complementary to psychological therapy.
Pharmacological treatment for post-traumatic stress disorder
First-line antidepressants are SSRIs and venlafaxine. SSRIs are a very versatile group of antidepressants in psychiatry, as they are used to treat depression, various types of anxiety, OCD and PTSD, among others. In particular, treatment with SSRIs has been shown to alleviate major symptoms of PTSD (hypervigilance, re-experiencing, avoidance, blunting of affect) in both women and men.
Antidepressants other than SSRIs can also relieve symptoms of PTSD. Drugs such as duloxetine, desvenlafaxine, trazodone, mirtazapine, and venlafaxine are frequently used in patients with PTSD.
Benzodiazepines are another group of medications commonly used to relieve anxiety and insomnia, although they do not improve the most important symptoms of post-traumatic stress disorder (PTSD). Instead, second-generation antipsychotics have been widely used in recent years because anticonvulsants have produced questionable results. We will now look at what these medications are.
Antidepressants for treating PTSD
SSRI antidepressants are the most effective for treating PTSD for the following reasons:
They improve basic symptoms of post-traumatic stress (hyperarousal, avoidance, and emotional blunting).
Reduce symptoms such as impulsivity, aggression and suicidal behavior, which can complicate the prognosis of PTSD.
They are also an effective treatment for stress-related post-traumatic stress disorder, such as anxiety, depression, panic attacks, social phobia and obsessive-compulsive symptoms.
Which antidepressant is best for treating post-traumatic stress disorder?
Clinical treatment guidelines recommend SSRI and SNRI antidepressants. There are only two antidepressants with indications for treating PTSD in Britain: sertraline and paroxetine. Between these two antidepressants, the NICE clinical guideline (2018) favors sertraline as the best antidepressant for PTSD. The reason is to avoid the withdrawal syndrome that can occur with Paroxetine. However, the same clinical guidelines, as well as others, suggest that any SSRI may be effective. Therefore, citalopram, escitalopram, fluvoxamine, or fluoxetine can also be used in the treatment of PTSD. Venlafaxine (IRNS) may also give good results in treating PTSD. In fact, when comparing different antidepressants to each other, no differences in efficacy have been found.
Benzodiazepines in the treatment of PTSD
Benzodiazepines are the group of drugs most commonly used as hypnotics (sleeping pills) and anxiolytics (relaxants). In the case of PTSD, benzodiazepines can contribute to anxiety and insomnia. However, unlike antidepressants, benzodiazepines do not improve the cardinal symptoms of PTSD. For this reason, benzodiazepines should not be prescribed alone but in combination with antidepressants.
Benzodiazepines have a risk of addiction with prolonged use and in susceptible individuals. Some people with PTSD are more likely to develop dependence on benzodiazepines, as well as alcohol and other drugs. In addition, the subsequent withdrawal of benzodiazepines may lead to a worsening of symptoms in some patients.
The most commonly used benzodiazepines are: lorazepam, lormetazepam, bromazepam, and diazepam.
Antipsychotics for PTSD
In recent years, second-generation antipsychotics have been used to treat post-traumatic stress disorder. They are especially helpful for those who develop psychotic symptoms in a post-traumatic context. Antipsychotics may also be necessary for patients whose symptoms do not improve with initial antidepressant medication and in whom benzodiazepines should be avoided. Antipsychotics help reduce anxiety, insomnia, intrusive symptoms and increased arousal.
The most commonly used antipsychotics to treat PTSD are risperidone, olanzapine, and quetiapine. The side effects of these three drugs, especially the risk of weight gain and metabolic changes, require careful monitoring by a mental health professional.
Treating nightmares for post-traumatic stress disorder
Prazosin, a drug marketed to treat hypertension, has been shown to be effective for nightmares in people diagnosed with PTSD. Although this drug is not an indication, it is a very interesting result because there are no drugs specifically designed to treat nightmares. People with PTSD can have very distressing and frequent nightmares, affecting rest and sleep quality.
Medications to prevent post-traumatic stress disorder
Attempts have been made to research various medications and substances that can be administered after exposure to a traumatic event in order to be able to prevent the development of PTSD symptoms. Benzodiazepines have been extensively studied for these indications, but have not demonstrated any benefit. Therefore, they should not be prescribed for this purpose.
Other medications studied were more successful, and some were found to have potential benefits. In particular, the immediate administration of morphine, hydrocortisone, or propranololol after exposure can alleviate symptoms. Despite these positive findings, given the research published to date, no medications can yet be recommended for the prevention of post-traumatic stress disorder.