SSRIs most effective in treating post-traumatic stress disorder

A variety of medications can help reduce the core symptoms of post-traumatic stress disorder (PTSD) as well as reduce associated depression and disability, but selective serotonin reuptake inhibitors (SSRIs) should be considered as first line agents as there is most evidence showing that these can be effective.

This was the conclusion of a systematic review that studied 25 short-term clinical trials involving 4,597 participants. It was published in the latest update of The Cochrane Library.

PTSD occurs after a person has been exposed to serious trauma such as involvement in a terrorist atrocity, combat or rape. It results in enormous personal and societal costs and has traditionally been treated by psychotherapy. But recent developments in the scientific understanding of changes in the brain associated with PTSD indicate that there may be a role for medication.

A wide range of pharmacological treatments has been used in an attempt to treat PTSD, including tricyclic antidepressants, SSRIs and anticonvulsants. “While there is no clear evidence that any pharmacological treatment is superior, currently the greatest number of trials has looked at SSRIs,” says lead author Prof Dan Stein who works in the Department of Psychiatry at the University of Cape Town, South Africa.

Some medications, however, have had a negative effect. These include benzodiazepines and inositol.

Studies of long-term interventions show that pharmacotherapy can increase its effectiveness over time, as well as act to prevent relapses.

“Its worth remembering that both pharmacotherapy and psychotherapy can have a useful role to play in the treatment of PTSD,” says Stein.