Text adapted from: "The adult patient with posttraumatic stress disorder," in Psychiatry in primary care by Francesca L. Schiavone and Ruth A. Lanius (CAMH, 2019).
Some patients prefer pharmacotherapy over psychotherapy, or find pharmacotherapy easier to access for financial or practical reasons (Hoskins et al., 2015). Even with patients who prefer psychotherapy, pharmacotherapy is important for treating comorbidity, mitigating sleep disruption and stabilizing patients whose symptoms are severe enough to prevent them from engaging in psychotherapy (Lange et al., 2000). A wide range of medications have been investigated, with some promising results (see Table 2 below ).
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are considered first-line interventions for PTSD, although only 20 to 30 percent of patients achieve complete remission on these medications (Berger et al., 2009; Hoskins et al., 2015). A small positive effect on overall PTSD severity has been found for SSRIs as a class, specifically for fluoxetine and paroxetine, as well as for the SNRI venlafaxine. Mirtazapine has shown some effectiveness and may be a useful adjunctive treatment for sleep problems (Hoskins et al., 2015).
Atypical antipsychotics are often used to treat PTSD, particularly as adjunctive agents in patients who remain symptomatic after SSRI treatment (Berger et al., 2009). The evidence for various atypical antipsychotics is mixed. The medications with the best evidence are olanzapine, risperidone and quetiapine. Risperidone and quetiapine have shown small positive effects, particularly on intrusion and hyperarousal symptoms.