The drug treatment of post-traumatic stress disorder

Many individuals with a history of psychological trauma continue to react to current life stresses as a recurrence of the original trauma, even though they rarely make a conscious connection between present distress and past trauma. Their hyperreactivity, reliving experiences, and difficulty in modulating the intensity of their anxiety, aggression and interpersonal attachments are sources of continuing stress to both themselves and their environment. Pharmacological treatments are often necessary to blunt the intensity of their response to subsequent stressors. Our knowledge about the drug treatment of post-traumatic stress disorder (PTSD) is still very limited. Existing reports are pretty much limited to one particular population with chronic PTSD: Vietnam veterans. Even less is known about effective pharmacological management of acute PTSD. While many psychotropic agents have been proposed for the treatment of various symptoms of PTSD, carefully controlled studies are lacking to clarify the relative merits of particular psychotropic agents on the various post-traumatic symptoms. Impressions in open studies have utilized global ratings, rather than studied the effects on specific symptoms. The animal model of inescapable shock provides a good model for understanding the biological alterations produced by overwhelming trauma, and suggests a variety of pharmacological treatment interventions. Elucidation of traumatic childhood antecedents of certain forms of adult psychopathology will provide clearer links between existing knowledge about effective pharmacological management and the treatment of post-traumatic states.