PTSD Medications
SSRIs:
· Selective Serotonin Reuptake Inhibitors
· Symptom clusters: targets all symptom clusters (DSM IV)
· Common side effects:
o Upset stomach
o Sexual dysfunction
· Serious side effects
o Suicide Risk: Black Box Warning under 24 years old
o Serotonin syndrome (fever, stiffness, agitation, tremor)
· Time to Effect
o 6-8 weeks at a therapeutic dose
· Medications
Generic / Brand / Dosing RangeCitalopram / Celexa / 10-40 mg daily
Escitalopram / Lexapro / 5-20 mg daily
Fluoxetine / Prozac / 10-80 mg daily
Paroxetine / Paxil / 10-60 mg daily
Sertraline / Zoloft / 25-200 mg daily
SNRIs:
Serotonin Norepinephrine Reuptake Inhibitors
Only venlafaxine has really been studied
Symptom clusters: targets all symptom clusters (DSM IV)
Common side effects:
Increased blood pressure
Upset stomach
Sexual dysfunction
Serious side effects
Suicide Risk: Black Box Warning under 24 years old
Serotonin syndrome (fever, stiffness, agitation, tremor)
Time to Effect
6-8 weeks at a therapeutic dose
Medications
Generic / Brand / Dosing RangeDesvenlafaxine / Pristiq / 50 mg daily
Duloxetine / Cymbalta / 20-120 mg daily
Venlafaxine / Effexor / 37.5 mg – 300 mg
Other Classes:
Mirtazapine (Remeron)
· Works in CNS to increase serotonin and norepinephrine availability
· Symptom clusters: targets all symptom clusters (DSM IV)
· Common side effects:
o Sleepiness (we can take advantage of this!)
o Increased hunger
o No sexual dysfunction
· Serious side effects
o Suicide Risk: Black Box Warning under 24 years old
o Serotonin syndrome (fever, stiffness, agitation, tremor)
· Time to Effect
o 6-8 weeks at a therapeutic dose
Prazosin (MiniPress)
· Old blood pressure medication working by α blockade and relaxing smooth muscle
· Symptom clusters: Re-experiencing (specifically nightmares), mixed for hyperarousal
· Common side effects:
o Dizziness
o Orthostatic hypotension
o Lethargy
· Serious Side effects: very rare
o Syncope
o Hypotension
· Time to effect:
o A couple weeks of titration
Benzodiazepines
· Contraindicated in PTSD, may be harmful and worsen symptoms
o Inhibits memory formation
· Common Side Effects
o Disinhibition
o Dizziness, unsteadiness
o Depression
o Sedation
o Cognitive effects
o Falls
o Rebound anxiety
· Serious Side Effects
o Physical dependence and abuse
o Severe withdrawal (tremor, anxiety, seizures, death)
o Risk in overdose: can be fatal in combination
o Drug Interactions
o Worsening of PTSD symptoms
· Time to effect: 15-60 minutes
o Note: Effect only lasts 2-12 hours
· Medications
Generic / Brand / Equivalent Dose / Dosing RangeAlprazolam / Xanax / 1 mg / 0.25 – 1 mg QID
(4 times daily)
Clonazepam / Klonopin / 0.5 mg / 0.25 – 2 mg BID
(2 times daily)
Diazepam / Valium / 10 mg / 2-10 mg BID-QID
(2-4 times daily)
Lorazepam / Ativan / 1 mg / 0.5 – 2 mg TID
(3 times daily)
VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress, 2010