PTSD Treatment and Medication: What Are the Options?
Every case of post-traumatic stress disorder (PTSD) is unique from a biological, psychological and social standpoint. Medications that work for one person may not be as effective for someone else. Some studies suggest cognitive behavioral therapy (CBT) is a more effective PTSD treatment than medication, although few head-to-head comparisons have been done. Some people prefer talk therapy, while others experience a clear reduction in symptoms when they take medications. Many individuals with PTSD benefit from taking medication in conjunction with psychotherapy. The challenge is that a single pharmacotherapy has not yet been developed specifically for the treatment of PTSD.
A Look at PTSD Medications
A large number of scientifically robust PTSD studies have been conducted on selective serotonin reuptake inhibitors (SSRIs), drugs typically prescribed for depression. SSRIs are associated with an overall response rate of approximately 60% in individuals with PTSD, yet only 20% to 30% achieve complete remission. An imbalance of the brain neurotransmitter serotonin is thought to be a contributing factor in PTSD, depression and other psychiatric disorders. SSRIs work by increasing levels of serotonin. Currently, the only two SSRIs approved by the Food and Drug Administration (FDA) for PTSD are sertraline (Zoloft) and paroxetine (Paxil). Despite this, fluoxetine and venlafaxine (a serotonin and norepinephrine reuptake inhibitor) are recommended as off-label, first-line treatments.
In a double-blind study involving individuals with chronic PTSD (symptoms lasting a minimum of six months), significantly greater improvements were seen in the sertraline group in three of four primary outcome measures. It was well-tolerated, with insomnia the only adverse event reported more often in those taking Zoloft than the placebo group. In addition to sleep issues, common side effects include dizziness, gastric distress (e.g. nausea, constipation or diarrhea), skin rash, headache, dry mouth, sexual problems and weight loss.
In a study involving 551 individuals with chronic PTSD, individuals taking either 20 mg or 40mg/day achieved significant improvements in primary outcome measures compared to the placebo group. Paroxetine was well-tolerated, with commonly reported adverse events including lack of energy/weakness, diarrhea, abnormal ejaculation, impotence, nausea and sleepiness. Other common side effects of Paxil include vision changes, dizziness, sweating, anxiety, shaking, insomnia, loss of appetite, constipation, dry mouth and yawning.
Although it is recommended as an off-label treatment for PTSD, study results have been mixed. In a small study involving civilians, individuals taking fluoxetine showed statistically significant improvements in symptoms. Studies involving combat veterans have yielded contradictory results. Common side effects of Prozac include insomnia, strange dreams, headache, dizziness, vision changes, tremors, feeling anxious, pain, weakness, yawning, feeling tired, gastric distress (e.g. nausea, constipation or diarrhea), dry mouth, sweating, hot flashes, changes in weight or appetite, stuffy nose, sinus pain, sore throat, flu symptoms and sexual problems.
Venlafaxine (Effexor XR)
In two studies involving more than 800 individuals with PTSD, extended-release venlafaxine showed response and remission rates of 78% and 40%, respectively, although the drug did not improve hyperarousal. Common side effects include gastric distress (e.g. nausea or constipation), insomnia, dizziness, lack of energy/weakness, drowsiness, dry mouth, nervousness, strange dreams, blurred vision, appetite or weight changes, sexual problems and increased sweating.
Specialists at PTSD treatment centers tailor treatment to the needs of each individual, taking into account these evidence-based facts:
- People with PTSD have high rates of co-occurring major depressive disorder and substance use disorders. Some PTSD medications may negatively impact co-occurring disorders or interact with other drugs.
- Individuals who are highly resilient tend to respond more quickly to medications than those who are less resilient.
- PTSD medications produce less-effective responses in older individuals than younger ones.
- Individuals with persistent, long-term PTSD symptoms (e.g. older veterans who have received PTSD treatment for decades) may not respond as well to new treatments.
- If a person experienced complex trauma, medications alone are less effective for treating personality disorders than a combination of psychotherapy and medications.
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