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, placebo-controlled clinical trials supports the use of antidepressants, especially tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin selective reuptake inhibitors (SSRIs). Although heightened anxiety is characteristic of PTSD, benzodiazepines have not yet proved useful in controlled trials and may be associated with a rebound effect on discontinuation. The small, open studies of anticonvulsant drugs indicate moderate to good improvement with these agents. Tricyclic, SSRI, and MAOI antidepressants have demonstrated efficacy in larger, longer-term controlled trials. Drug/psychotherapy combinations may enhance the usefulness of psychotherapeutics in the management of PTSD. Studies with tricyclics and fluoxetine indicate that magnitude and type of trauma may determine the degree of response.