A Guide To The Medications Used For The Treatment Of PTSD

What is the first-choice treatment for PTSD?

The first-choice treatment for PTSD¹ is actually not medication. Instead, it is trauma-focused therapy (outlined below).

In general, studies indicate that therapy is more effective at treating PTSD² than medications are. However, some people with PTSD also benefit from prescription medications.

There’s still a lot that’s unknown about how PTSD affects the body and brain, which makes it more difficult to develop effective treatment options, especially medications.

Some studies³ have found that people with PTSD have increased signaling by certain brain chemicals that activate the fight-or-flight response. This leads the brain to become excessively responsive to potential threats.

Treatment is generally focused on reducing the brain’s threat signaling. This can be accomplished with therapy and/or with medications.

Medications for PTSD

While therapy is usually preferred as the first-line treatment for PTSD, medications can also be useful for some patients. Only one class of medications is FDA-approved for treating PTSD, although other medications may be used in cases where these are ineffective.

SSRIs (Antidepressants) for PTSD

A class of medications called selective serotonin reuptake inhibitors, or SSRIs, has been shown to be effective for PTSD. These medications are commonly known as antidepressants. They increase the levels of a brain chemical called serotonin, which can reduce feelings of depression and anxiety in many people. The most common SSRIs used for PTSD include:

• Fluoxetine (sold under the brand name Prozac)

• Paroxetine (sold under the brand name Paxil)

• Sertraline (sold under the brand name Zoloft)

When compared with people receiving a placebo (an inactive pill used for comparison), patients receiving an SSRI have been shown⁴ to have fewer symptoms like re-experiencing, hyperarousal, and avoidance.

A decrease in relapse rates⁵ has also been found in patients taking SSRIs. These medications are generally considered safe, with a low risk of serious side effects, and are the preferred medication option for people with PTSD.

Although SSRIs all work in the same way, some patients may respond better to one of them than others. The response to particular SSRIs varies from person to person and can be influenced by various factors.

For example, some people have genetic variations⁶ that prevent certain SSRIs from entering the brain. If you try an SSRI and it’s not effective or has side effects, then your doctor may try prescribing a different SSRI to see if it works better for you.

Other medications for PTSD

Currently, SSRIs are the only drugs that are FDA-approved for PTSD. These drugs are usually tried first if doctors prescribe pharmaceutical therapy for PTSD. However, other medication options may be prescribed if they don’t work well for a particular patient.

These include other types of antidepressants (such as venlafaxine, sold under the brand name Effexor, and duloxetine, sold under the brand name Cymbalta) as well as a group of medications known as atypical antipsychotics (which include quetiapine, sold under the brand name Seroquel, and olanzapine, sold under the brand name Zyprexa). 

Therapies for PTSD

Trauma-focused therapy is generally considered the most effective treatment option for PTSD. The World Health Organization⁷ recommends that therapy be used as the first-line treatment option for PTSD, with medications being offered if therapy is ineffective. There are a few different types of therapy that may be used.

Cognitive processing therapy

This form of cognitive therapy focuses on how the brain misinterprets signals from the environment and considers them to be threats.

Essentially, with PTSD, there is an increase in signaling in certain circuits in the brain, which leads to the activation of the fight-or-flight response and causes an overactive response to threats.

Cognitive processing therapy works by helping you to identify and change your brain’s misinterpretation of signals, so they don’t activate the fight-or-flight response.

Prolonged exposure therapy

In this form of therapy, a therapist will help you to walk through your traumatic experience.

This process can be emotionally challenging, but by having to confront your trauma in a safe space, you are more able to realize that you are safe when your trauma gets triggered in real life.

Eye movement desensitization and reprocessing

This is a trauma-focused⁸ form of therapy where, as the event is recalled, there is a rhythmic physical stimulation to both sides of the body, which may include eye movements, tapping, or tones. 

This is believed to help process the experience of the trauma fully and change the brain’s response to the memory. Afterward, when the memory is triggered, you will remember that you are now safe, and the trauma response will be reduced or eliminated.

Cognitive behavioral therapy

It has been found that, for patients with PTSD, attachment in adulthood⁹ is often difficult. People with PTSD may find it difficult to create and maintain relationships. Supportive relationships are crucial for mental health, so addressing this issue is very important.

This can be accomplished through interventions that aim to enhance attachment security, such as cognitive behavioral therapy (CBT).¹⁰

CBT can help by modifying the belief system around how you respond during a traumatic event. Often, a traumatized person’s own actions during the event can be a source of shame. For example, you might think that the event wouldn’t have occurred if you had done something differently.

During CBT, the therapist will help you become aware of your beliefs about the traumatic event and replace them with healthier ones. This can help reduce feelings like shame and guilt, making it easier to relate to others. 

Treating PTSD and co-occurring conditions

People with PTSD often experience conditions like depression and anxiety, which may be related to the traumatic event and its effects. It’s important to address these issues to improve the quality of life for people with PTSD.

Much like PTSD itself, depression and anxiety can be treated with either therapy like cognitive behavioral therapy — to treat the thinking around the event that leads to depression and anxiety — or through pharmaceutical interventions like antidepressants.

The lowdown

PTSD is a complex disorder that we still don’t fully understand. However, the use of both medicinal and therapeutic interventions is working to help reduce the effect of PTSD on individuals.

These include both antidepressants and therapies such as cognitive behavioral therapy.

Therapy, over medical intervention, is generally considered the preferred treatment for someone with PTSD, although medications may also be helpful.

Treatment and recovery are possible if you or someone you know has PTSD. The first step to recovery is to see a medical professional.