Medications for PTSD: A Comprehensive Guide
Medications for Depression and Anxiety Associated with PTSD
When someone starts a medication for PTSD, the first medication they usually try is an antidepressant. There are two classes of antidepressants recommended for PTSD: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
The most common antidepressants for PTSD include:
- Sertraline
- Paxil (Paroxetine)
- Fluoxetine
- Effexor XR (Venlafaxine)
A review of multiple studies examined each SSRI or SNRI’s effectiveness at reducing PTSD symptoms:
- Fluoxetine: Despite a modest 28% reduction in PTSD symptoms, fluoxetine is often preferred due to its minimal side effects and good tolerability after stopping the medication.
- Sertraline: Sertraline, while well-tolerated and shown to reduce PTSD symptoms by 20%, should be avoided by those with heart rhythm issues due to the increased risk of QT prolongation.
- Paroxetine: Paroxetine, though the most effective SSRI for PTSD with a 44% to 56% reduction in symptoms, has the most side effects and poorest tolerability upon discontinuation.
- Venlafaxine: Venlafaxine, an SNRI with a 26% to 35% PTSD symptom reduction, has more side effects than SSRIs, including increased blood pressure and insomnia.
Medications for Sleep Issues Associated with PTSD
Research has shown that a medication called prazosin can effectively reduce nightmares and promote better sleep among those with trauma-related nightmares or sleep disturbances.
Prazosin is classified as an alpha-adrenergic receptor blocker. It can inhibit alpha receptors on the walls of blood vessels and in the brain. When prazosin enters the brain, it can block the release of stress hormones and enhance sleep quality. If you are having difficulty sleeping, prazosin can be used alone or in addition to an SSRI or SNRI.
Medications for Psychosis Associated with PTSD
Those who experience PTSD-related psychosis symptoms, such as dissociation, hallucinations, or delusions, can take second-generation antipsychotics.
Common antipsychotics used in PTSD include:
- Seroquel (quetiapine)
- Risperdal (risperidone)
- Zyprexa (olanzapine)
From a collection of limited studies available, second-generation antipsychotics showed a minimal reduction of PTSD symptoms, ranging from 1.5% to 26%. Antipsychotics are usually recommended when antidepressants do not work. They can be taken alone or in combination with an SSRI or SNRI.
Medications to Avoid
Some medications should be avoided due to the lack of supporting evidence for their safety and efficacy. In addition, these medications may intensify the fear response associated with PTSD.
Medications that are not recommended to treat PTSD are:
- Benzodiazepines: Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam), Klonopin (clonazepam)
- Cannabis or cannabis derivatives: tetrahydrocannabinol, cannabidiol
Other Treatment Options
Other than medications, trauma-based therapy is a common method for managing and reducing PTSD symptoms. There are three types of trauma-based therapy:
- Prolonged exposure (PE): Teaches you how to slowly approach memories and feelings that you have been avoiding since your trauma. It involves talking about your experience to a therapist and exposing yourself to activities that you have been avoiding since the traumatic event.
- Cognitive processing therapy (CPT): Helps you recognize and challenge negative thoughts. It teaches people how to evaluate their thoughts and develop more helpful ways of thinking.
- Eye-movement desensitization and reprocessing (EMDR): Involves recalling a traumatic memory while paying attention to back-and-forth movement, such as moving your eyes from side to side or listening to tones. The stimulation is believed to help process the traumatic memories and reduce their vividness and emotional impact.
Conclusion
If you have PTSD, trying trauma-based therapy first before starting medications is best. However, medications can provide added support for managing symptoms if therapy alone does not work. Choosing the right medication for PTSD is a personal decision that you should discuss with your healthcare provider. They can assess your specific symptoms, medical history, and other factors to determine the most appropriate and effective treatment plan for you.
FAQs
- What are the most common medications used to treat PTSD?
- SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are commonly used to treat PTSD.
- What are some common side effects of SSRIs and SNRIs?
- Common side effects of SSRIs and SNRIs include headaches, nausea, and dizziness.
- Can I take medications for sleep issues associated with PTSD?
- Yes, prazosin is a medication that can help reduce nightmares and promote better sleep among those with trauma-related nightmares or sleep disturbances.
- Are antipsychotics effective in treating PTSD?
- Second-generation antipsychotics may be effective in reducing PTSD symptoms, but more research is needed to confirm their effectiveness.
- What are some medications to avoid when treating PTSD?
- Benzodiazepines, cannabis or cannabis derivatives, and tricyclic antidepressants are not recommended for treating PTSD.
