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What Types Of Medications Are Used In The Treatment Of Post-Traumatic Stress Disorder (PTSD)?

by — Last updated: 2020-05-30 in Mental Health

If you've been diagnosed with PTSD, talk therapy is the first-line treatment option. Some people with post-traumatic stress disorder are also prescribed medications, however. What kinds have been proven to work?

If you've read anything about post-traumatic stress disorder before, chances are you've heard it described as "a normal reaction to abnormal circumstances". While that school of thought certainly helps humanize people with PTSD rather than painting them as weak or broken, it ignores the fact that trauma doesn't really fall under "abnormal circumstances". Instead, it's shockingly common. 

An estimated 10 percent of people who live through trauma will develop post-traumatic stress disorder — in the US, 20 percent of civilian women and eight percent of civilian men, along with 16 percent of combat veterans, will have PTSD at some point in their lives. 

Fortunately, post-traumatic stress disorder doesn't have to be a life sentence. It can be managed, and remission is possible. 

Why don't you hear much about medications as a treatment for PTSD?

Most people who are diagnosed with post-traumatic stress disorder and enter treatment will opt for psychotherapy, because that's what they'll be offered based on current evidence.

This usually means "talk therapy", where a therapist and a trauma survivor with PTSD work on healing, in various ways, by talking about the symptoms of PTSD and how to manage them, the trauma, and other underlying issues.

Examples of the most effective talk therapy approaches for PTSD include:

Eye movement desensitization and reprocessing therapy — EMDR for short — is another kind of psychotherapy that really doesn't involve much talking, however, and that has been shown to have some promise.

US Veterans Affairs strongly recommend psychotherapy as a first-line treatment for PTSD, and their guidelines suggest that PTSD treatment with medications should be reserved for people who either prefer this approach (that is, don't want talk therapy) or don't have access to psychotherapy. A third group who would benefit from pharmacotherapy for PTSD would, of course, be people with PTSD who attend talk therapy but still struggle so much that they might benefit from medications alongside their therapy programs. 

What medications can help in the treatment of post-traumatic stress disorder?

The main kinds of symptoms that would lead someone living with PTSD to perhaps seek out medications would be:

  • Emotional difficulties like emotional numbness, anger, or depression that exists alongside PTSD. 
  • Trouble sleeping due to nightmares or insomnia. 
  • Extreme emotional reactions when triggered. 

So, medications that reduce these PTSD symptoms need to act on the parts of the brain, or its chemistry, that play a role in causing these symptoms.

It's no surprise that antidepressants are the main class of medications that can help some people with post-traumatic stress disorder. The SSRI antidepressants sertraline (Zoloft) and paroxetine (Paxil) have both been FDA-approved specifically to treat PTSD, while of course keeping in mind that the prescribing doctor needs to take other conditions and potential interactions in mind. Both these drugs have been shown to be effective at reducing PTSD symptoms.

Another well-known SSRI, fluoxetine (you'll probably know it as Prozac) can be considered off-label. The same is true for venlafaxine (Effexor). 

Other antidepressants have also been considered:

  • The atypical antidepressant nefazodone has been shown to be effective at reducing PTSD symptoms, but has the potential to cause liver toxicity; especially harmful if someone with PTSD also has an alcohol use disorder. 
  • Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) tend to come with lifestyle restrictions and/or numerous potential side effects, which is why they are not usually recommended. A possible exception is the MAOI phenelzine (Nardil). 

Anticonvulsants (medications originally developed for epilepsy) like topiramate are also sometimes prescribed to people with post-traumatic stress disorder, again off-label, or when someone with PTSD also has bipolar disorder. 

Beta blockers may be prescribed to people who especially struggle with hyperarousal symptoms (like hypervigilance and a quick startle response). 

Benzodiazepines are, meanwhile, not recommended for PTSD by US Veterans Affairs. Not only are they habit-forming (yes, addictive!), they've also been shown to have the potential to actually worsen post-traumatic stress disorder symptoms. 

What now?

Because talk therapy is very much the norm when it comes to PTSD treatment, chances are that you'll have a hard time getting antidepressants or anything else even if you really want them — because you're struggling and psychotherapy isn't helping enough, or you're stuck on a wait list somewhere. 

Though certain SSRI antidepressants can do a good job at offering you fairly quick relief in taking the edge off some of the core symptoms of post-traumatic stress disorder, talk therapy is strongly recommended for a reason. It might not work quickly, and therapy might even make some of your PTSD symptoms worse for a time, but it is the recommended PTSD treatment because it has higher success rates. 

Having said that, if you can't access therapy, really aren't ready for it, or your talk therapy is leaving you in a position where you feel you can't cope any longer, there's no reason not to ask your doctor about medications. They're the right choice for some people, and you may be one of them. 

  • Photo courtesy of SteadyHealth