Management of PTSD
Carol S. North, MD, MPE, DFAPA, University of Texas Southwestern Medical Center
The pathology of PTSD is thought to be related to abnormal neurobiological processing of acquired fear responses. Psychotherapy and pharmacotherapy have demonstrated effectiveness in PTSD, but it is unclear if either modality alone or combined is better; treatment choice should be guided by patient preference. Sertraline and paroxetine have FDA indications for PTSD, but all selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are considered first-line agents. Prazosin is effective for nightmares and sleep disturbances. Sedative-hypnotics and benzodiazepines can relieve specific symptoms, such as anxiety or insomnia, but do not address all PTSD symptomatology. Cognitive processing therapy and prolonged exposure therapy have the best evidence of efficacy.
