Psychopharmacology in post traumatic stress disorder (PTSD)

psychopharmacology

Drug treatment (1)

Do not offer drug treatments, including benzodiazepines, to prevent PTSD in adult.

Treatment of PTSD:

• either an SSRI or venlafaxine could be considered if a person prefers to have drug treatment, but they should not be offered as first-line treatment for PTSD (1) Antipsychotic treatment should be started and reviewed regularly by a specialist - antipsychotics should not be seen as an alternative to a trauma-focused psychological intervention as first-line treatment for PTSD and should only be considered as an adjunct to psychological therapy
  • venlafaxine* or a SSRI, such as sertraline, should be considered ** for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Review this treatment regularly
    
    
  • consider antipsychotics such as risperidone***, in addition to psychological therapies to manage symptoms for adults with a diagnosis of PTSD if:
    • they have disabling symptoms and behaviours, for example severe hyperarousal or psychotic symptoms
      • and their symptoms have not responded to other drug or psychological treatments
        
        
  • however, they might be beneficial for symptom management for adults with a diagnosis of PTSD if their symptoms have not responded to other drug or psychological treatments and they have disabling symptoms and behaviours that makes it difficult for them to engage with psychological treatment
  • given the different side effect profiles, the committee agreed to leave the choice of antipsychotic to clinical judgement but risperidone was included as an example in the guideline because the evidence for risperidone included more participants

* At the time of publication (December 2018), venlafaxine did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the GMC's Prescribing guidance: prescribing unlicensed medicines for further information.

**At the time of publication (December 2018), only sertraline and paroxetine have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the GMC's Prescribing guidance: prescribing unlicensed medicines for further information.

***At the time of publication (December 2018), risperidone did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the GMC's Prescribing guidance: prescribing unlicensed medicines for further information.

See full NICE guideline for more detailed guidance (1).

Necessary self-help advice for people with PSTD and advice for carers, relatives and colleagues can be found in the PTSD leaflet issued by the Royal College of Psychiatrists (2).

People suffering from PTSD should be provided with information regarding support groups (1).

The prognosis for cases of long-standing PTSD is worse than for acute cases.

Reference:

• (1) NICE (December 2018).Post-traumatic stress disorder (NG116)
• (2) The Royal College of Psychiatrists 2010. Post Traumatic Stress Disorder (PTSD)