Treatment for posttraumatic stress disorder

OBJECTIVE: To thoroughly and critically review the pharmacologic treatment of posttraumatic stress disorder (PTSD) and to review the symptomatology, diagnosis, epidemiology, pathophysiology, and assessment of PTSD. DATA SOURCES: A MEDLINE search (1966-October 1999) in the English language specifying PTSD drug treatment as the search term was used to identify articles. STUDY SELECTION AND DATA EXTRACTION: All articles identified were reviewed; emphasis was given to randomized, double-blind, placebo-controlled studies. DATA SYNTHESIS: It appears that a five-week medication trial is necessary to assess clinical effects on PTSD symptoms. The monoamine oxidase inhibitors appear to be superior to the tricyclic antidepressants in improving reexperiencing and avoidance symptoms. Most studies used assessment tools that neglected hyperarousal symptoms; therefore, no conclusions regarding this symptom cluster can be drawn. Other pharmacotherapeutic interventions reported in open-label trials have yielded varying success. CONCLUSIONS: The current literature does not bear a sufficient number of double-blind, placebo-controlled studies using assessment tools that evaluate the three symptom clusters of PTSD to allow for a definite treatment modality to be formulated. Nonetheless, a treatment hierarchy appears to be in order based on the greatest number of double-blind, placebo-controlled studies evaluating antidepressants. Alternate modalities such as mood stabilizers, antipsychotics, anxiolytics, and adrenergic blockers should not be considered the mainstays of therapy.

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