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Pharmacotherapy for posttraumatic stress disorder: review with clinical applications

Pharmacotherapy for posttraumatic stress disorder: review with clinical applications. Matthew Jeffreys, MD; Bruce Capehart, MD, MBA; Matthew J. Friedman, MD, PhD. Aim

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Pharmacotherapy for posttraumatic stress disorder: review with clinical applications

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  1. Pharmacotherapy for posttraumatic stress disorder: review with clinical applications Matthew Jeffreys, MD; Bruce Capehart, MD, MBA; Matthew J. Friedman, MD, PhD

  2. Aim • Review pharmacotherapy recommendations from 2010 Department of Veterans Affairs (VA)/Department of Defense (DOD) Clinical Practice Guideline for posttraumatic stress disorder (PTSD). • Provide practical PTSD treatment recommendations for clinicians. • Relevance • While evidence-based, trauma-focused psychotherapy is preferred, pharmacotherapy is also important PTSD treatment option.

  3. Stepped care for pharmacotherapy in PTSD. Adapted from VA/DOD Clinical Practice Guideline for PTSD.

  4. Recommendations • First-line: • Selective serotonin reuptake inhibitors. • Venlafaxine. • Selective serotonin-norepinephrine reuptake inhibitor. • Second-line: • Nefazodone, mirtazapine, tricyclic antidepressants, monoamine oxidase inhibitors. • Less evidence for usefulness and potentially greater side effect burden. • Prazosin beneficial for nightmares. • Benzodiazepines, antipsychotics not recommended.

  5. Conclusions • Effective screening for PTSD and trauma-related distress helps patient and staff understand emotional factors affecting recovery. • First- and second-line pharmacotherapy must be distinguished and discussed with patients in context of strong treatment alliance. • Co-occurring disorders (e.g., major depressive disorder, substance use disorder, and traumatic brain injury) must be treated to maximize PTSD treatment outcomes.

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