Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy

Recent evidence suggests that an etiologic model of posttraumatic stress disorder (PTSD) must include both vulnerability factors (presumably related to dysregulation of stress responses and/or failure of normal restitutive mechanisms following trauma) and factors related to trauma severity. The fact that rates of PTSD increase with the severity of trauma suggests that normal adaptive mechanisms may become overwhelmed even in the absence of vulnerability factors. Consistent with this view, efforts to demarcate normative from disordered reactions to severe trauma, such as the new diagnosis of acute stress disorder, have had limited success. Debate over the moral and scientific implications of receiving a trauma-related diagnosis has further complicated the issue and perpetuated a false dichotomy concerning normative responses. The literature on clinical trials in PTSD is reviewed. The range of treatment responses, and the categorical breadth of compounds studied, requires interpretation before the literature as a whole can be understood. One of the many limitations of this new literature is the absence of treatment-outcomes research on individuals with the common comorbidity of substance abuse. The most recent findings with selective serotonin-reuptake inhibitors and related compounds indicate a more optimistic outlook for pharmacological treatment of PTSD than was suggested by earlier trials. Given these observations, investigators will hopefully be encouraged to pursue study and development of treatment models that include both pharmacological and psychosocial interventions.