Biological Therapies for Posttraumatic Stress Disorder: An Overview

Both core and secondary symptoms of posttraumatic stress disorder (PTSD) respond to medication,a valuable part of overall PTSD treatment. Treatment options include antidepressants, anxiolytics, anticonvulsants,and mood stabilizers. A growing data base of results from double-blind, placebocontrolledclinical trials supports the use of antidepressants, especially tricyclics, monoamine oxidaseinhibitors (MAOIs), and serotonin selective reuptake inhibitors (SSRIs). Although heightened anxietyis characteristic of PTSD, benzodiazepines have not yet proved useful in controlled trials and may beassociated with a rebound effect on discontinuation. The small, open studies of anticonvulsant drugsindicate moderate to good improvement with these agents. Tricyclic, SSRI, and MAOI antidepressantshave demonstrated efficacy in larger, longer-term controlled trials. Drug/psychotherapy combinationsmay enhance the usefulness of psychotherapeutics in the management of PTSD. Studies with tricyclicsand fluoxetine indicate that magnitude and type of trauma may determine the degree of response.