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Updated PTSD guidelines recommend SSRIs, exposure therapy
Patients with posttraumatic stress disorder may benefit from various antidepressants, adrenergic agents, and second-generation antipsychotic drugs, according to the American Psychiatric Association’s updated Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder.
In the updated 2009 guideline, the APA provided an overview of key findings from randomized controlled studies of pharmacologic and psychotherapeutic treatments of PTSD since the 2004 edition of the guideline. The guideline reported no major research since 2004 on acute stress disorder.
Several randomized, controlled trials and meta-analyses published since 2004 support the use of selective serotonin reuptake inhibitors (SSRIs) and serontonin-norepinephrine reuptake inhibitors (SNRIs) for the treatment of noncombat PTSD. The strongest evidence was seen for SSRIs across all assemblages of symptoms. For combat veterans, however, the use of SSRIs yielded mixed results. While SSRIs were considered first-line treatment for combat-related PTSD, the updated guideline expressed uncertainty and the need for further studies.
The adrenergic agent prazosin has achieved noteworthy results in placebo-controlled augmentation trials in treating trauma-related nightmares and sleep disruption. Second-generation antipsychotic medications also have shown potential as an adjunctive treatment for PTSD patients who have achieved a partial response to treatment with an SSRI or SNRI.
The guideline also cited updated data on different psychotherapeutic approaches to PTSD. In particular, studies published since 2004 have yielded positive results in treating PTSD with exposure-based cognitive-behavioral therapies. These include cognitive-processing therapy and prolonged exposure therapy. While eye-movement desensitization and reprocessing therapy demonstrated efficacy in sexual assault victims and witnesses of car accidents, these results were not applicable to combat veterans. Although group therapy appears to have utility as a psychotherapeutic delivery format for PTSD, further studies are needed to confirm this, according to the guideline.