Medications for PTSD

There are many different types of medications that have been used to treat PTSD and symptoms of PTSD, ranging from benzodiazepines to sleep aids and sedatives to antidepressants. 

Other types of medications, such as the anti-epileptic medication topiramate, have also been considered for PTSD, but side effects for these medications are often considered to outweigh the potential benefits.

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are the most commonly used medications to treat PTSD today, as the side effects from benzodiazepines and sedatives are often too substantial. Only sertraline (Zoloft) and paroxetine (Paxil) are FDA approved to treat PTSD, but fluoxetine (Prozac) and venlafaxine (Effexor) are regularly used “off-label.” 

What Is PTSD?

PTSD (post-traumatic stress disorder) is a common condition that will impact 6 out of every 100 people in their lifetime, affecting more than 12 million adults any given year. 

PTSD is a mental health disorder that occurs as a result of experiencing or witnessing trauma. It can lead to nightmares, extreme anxiety, uncontrollable thoughts about the event, and a feeling of being in danger when you are not. 

Sertraline (Zoloft)

Sertraline hydrochloride, known by the brand name Zoloft, is an SSRI antidepressant medication that is FDA approved as a first-line treatment for PTSD. 

Zoloft works by inhibiting the reuptake of serotonin in the brain. This means that the medication blocks some of the serotonin, a positive mood-altering neurotransmitter produced by the brain, from being reabsorbed, meaning that more is left available. This can help to produce feelings of calm and promote better sleep and relaxation, all of which are disrupted by PTSD.

Zoloft has been shown to be effective at improving the following clusters of PTSD symptoms:

• Reexperiencing/intrusion
• Avoidance/numbing
• Hyperarousal

PTSD commonly co-occurs with other mental health conditions, including depression and substance use disorders. Antidepressant medications can often help to regulate moods related to each of these conditions simultaneously.

Paroxetine (Paxil)

Also an SSRI, paroxetine (known by the brand name Paxil) works to treat PTSD by keeping levels of serotonin higher in the brain. 

Paroxetine has a similar mechanism of action to sertraline, and both can be effective in treating PTSD and helping to manage symptoms. Paxil is available in tablets and suspension form to be taken orally as directed by a medical practitioner. 

Everyone responds differently to medications, and some people might tolerate Zoloft better than Paxil, as it can have slightly fewer side effects. This can also depend on your specific medical history and potential comorbid health and mental health conditions. 

Paxil is the only other medication FDA approved to treat PTSD as a front-line option.

Fluoxetine (Prozac)

Fluoxetine, known by the brand name Prozac, is another SSRI that is used off-label to treat PTSD. While it is not directly FDA approved for the treatment of PTSD, it can still be effective at helping to manage symptoms. 

Studies have shown that fluoxetine is very effective at treating severe PTSD symptoms. 

Prozac is FDA approved to treat the following:

• Major depressive disorder (MDD)
• Obsessive-compulsive disorder (OCD)
• Bulimia nervosa
• Panic disorder
• Depressive episodes associated with bipolar I disorder
• Treatment-resistant depression in adults

Since PTSD commonly co-occurs with other mental health conditions, Prozac can be a beneficial medication for treating them.

Venlafaxine (Effexor)

Venlafaxine, known by the brand name Effexor, is an antidepressant medication that is FDA-approved to effectively treat major depressive disorder (MDD) and used off-label to treat PTSD. 

Effexor is an SNRI medication. At low doses, it works to block serotonin from being reabsorbed, while it also keeps norepinephrine from being reabsorbed at higher doses. This helps to boost the mood-altering levels of these naturally occurring brain chemicals by keeping the nerve cells from reabsorbing them as quickly. 

As an SNRI, Effexor may take effect on depressive symptoms more quickly than an SSRI, but people often find that SSRIs are more effective for these symptoms overall. It can take trial and error to find the right medication. It is important to work with your health care provider to ensure that the medication is the right fit for you.

Other Helpful Treatments for PTSD

Medications are best used in conjunction with other psychological interventions. Psychological support is the most important treatment for PTSD. 

There are several different forms of therapeutic interventions that are effective in treating PTSD, such as cognitive behavior therapy, cognitive processing therapy, prolonged exposure therapy, and eye movement desensitization and reprocessing. 

In addition to therapeutic interventions and medications, the following can help manage the symptoms of PTSD:

• Eat a healthy, balanced, and nutritious diet.
• Attend support group meetings.
• Get enough exercise.
• Learn about the disorder.
• Treat any co-occurring disorders at the same time .

Cognitive Behavioral Therapy (CBT)

Trauma-focused cognitive behavioral therapy (CBT) aims to change negative patterns of thinking, behaviors, and emotions. CBT is usually administered over 12 to 16 sessions, and it can be done as individual or group therapy. 

CBT helps to support a more balanced way of thinking by looking at specific behaviors and pinpointing what emotions are driving these actions and how to positively influence them. Using CBT, people with PTSD are able to better define their triggers and develop healthy coping strategies to manage them.

CBT is considered both a safe and effective therapy with short- and long-term benefits for children and adults with PTSD. In one study, between 61 and 82.4 percent of people treated with CBT lost their PTSD diagnosis at a six-month follow-up. 

One of the biggest challenges of CBT, and therapy in general, is the high dropout rate. However, when people work through the treatment plan, high success rates are achieved. 

Cognitive Processing Therapy

A more specific form of CBT, cognitive processing therapy (CPT), is a trauma-focused approach that is usually delivered in 12 sessions to effectively treat PTSD. 

CPT can be delivered both in individual and structured group sessions. It involves a written trauma account and out-of-session practice assignments. 

A person will write a detailed account of traumatic experiences. In following sessions, they will read that account aloud, working through negative emotions and avoidance behaviors that will be triggered in an effort to modify maladaptive thinking. This can help to identify negative thoughts and behaviors related to the trauma and develop skills and adaptive strategies outside of treatment.

According to scientific studies, people with PTSD who have been treated with CPT fared better than nearly all (89 percent) of those who received no treatment at all. Cognitive processing therapy can have lasting benefits that can extend beyond just the treatment for PTSD.

Prolonged Exposure Therapy

Another specific form of trauma-focused CBT, prolonged exposure (PE) therapy is one of the most strongly recommended treatment types for PTSD. With prolonged exposure therapy, the individual learns how to confront their fears by learning that trauma-related memories and triggers are not dangerous and do not need to be avoided. 

With prolonged exposure therapy, an individual will attend weekly sessions (for about three months) of 60 to 120 minutes each time. Breathing techniques are taught to manage anxiety, as facing the trauma can be challenging at first. 

Both imaginal and in vivo exposure are used to face trauma-specific fears. With imaginal exposure, the individual works through talking about the trauma with guidance from the therapist. 

In vivo exposure involves specific situations or stimuli that are connected to traumatic fear. Time is spent planning out how to confront this successfully outside of the sessions.

Prolonged exposure therapy is an extremely effective therapeutic model for treating PTSD. In one study, the number of participants who screened positive for PTSD dropped nearly in half after PE therapy, from 87.6 percent to 46.2 percent.

Eye Movement Desensitization & Reprocessing (EMDR)

EMDR (eye movement desensitization and reprocessing) involves bilateral stimulation, which is eye movement, while briefly focusing on the trauma memory to help reduce the intensity of the emotions and memories of the event. 

EMDR is typically delivered once or twice a week for 6 to 12 sessions. EMDR is a highly structured therapeutic model with lower dropout rates and higher levels of efficacy when compared to both no treatment and other treatment models.

EMDR can effectively treat trauma and co-occurring disorders. It can help manage the following:

• Depression
• Anxiety
• Symptoms of PTSD
• Severe fatigue
• Paranoid thoughts
• Subjective distress
• Inability to function

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More