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Pharmacological treatment approaches to ptsd

A substantial body of research demonstrated abnormalities in psychobiological systems and function in persons with PTSD. The strongest evidence shows alteration of adrenergic and hypothalamicpituitary-adrenocortical (HPA) mechanisms, elevated physiological reactivity, and sleep disturbances. Many medications have been used to treat specific PTSD symptoms, separately or in combination with psychotherapy.
Pharmacological treatments for PTSD have included antidepressants, such as selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Other drugs evaluated for their efficacy against specific PTSD symptoms are inhibitors of adrenergic activity, including propranolol and clonidine; benzodiazepines, such as alprazolam (though the patients must be thoroughly evaluated for the potential for substance abuse); and antimanic drugs, including carbamazepine and lithium carbonate. Among drugs applied to the treatment of PTSD, the most widely studied and most widely prescribed are antidepressants. Antidepressants are the only drugs that have been tested for PTSD outcome efficacy under doubleblind experimental conditions. Several randomized clinical trials examined the efficacy of SSRIs (fluoxetine and sertraline) for reducing symptoms of PTSD. A majority of the studies found that SSRI treatments led to more improvement in PTSD symptoms than a placebo. Several studies of the PTSD efficacy of older antidepressants (MAOIs and TCAs) reported significant effects, whereas other doubleblind comparisons of antidepressants and placebo have reported no differences in PTSD treatment efficacy.
Although findings on the outcome efficacy of TCA and MAOI antidepressant medications for PTSD are mixed, evidence from clinical trials indicates that the SSRI antidepressants are currently the most efficacious drug treatment for PTSD.

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