Chapter 10: Post-traumatic Stress Disorder

Which medication can be used to treat sleep disturbances in patients with PTSD?

Trazodone

Which SNRI should be avoided in severe renal dysfunction?

Venlafaxine

Which medication should not be used as monotherapy for PTSD?

Benzodiazepines - Due to the effects on disinhibition and the high rates of substance use disorders in patients with PTSD

What psychological approaches are appropriate to treat PTSD?

CBT, especially trauma-focused CBT - Support that does not deal with the trauma directly is no more effective than being on a waiting list

Which CYP enzyme is Trazodone metabolized by?

CYP 3A4 - Inhibitors: Clarithromycin, Erythromycin, Grapefruit Juice, Ketoconazole - Inducers: Carbamazepine, Phenytoin, Rifampin

Which antidepressants are first-line options to reduce the severity of PTSD?

Fluoxetine, Sertraline, Venlafaxine

What antidepressants are second-line options to treat PTSD?

Fluvoxamine, Mirtazapine, Moclobemide, Phenelzine

Which drug should not be used with MAOIs?

Mirtazapine

What types or disorders should be treated as the primary condition?

Mood disorders, especially depression - Should also treat chronic pain and sleep disturbances

Do most people who experience trauma go on to develop either acute stress disorder or PSTD?

No

Should psychotherapy or pharmacotherapy (e.g. benzodiazepines) be started in the first 4 weeks following a traumatic event?

No - Psychological debriefing, a short intervention delivered in group settings during the first 2 weeks following a traumatic event, may hamper natural recovery and is usually not recommended.

Which two antidepressants are preferred for PTSD while breastfeeding?

Paroxetine and Sertraline

What medication can be used to reduce the frequency and intensity of nightmares and improving sleep in patients with PTSD?

Prazosin

What class of medication is the mainstay of pharmacologic therapy for PTSD during pregnancy?

SSRIs or SNRIs

What antipsychotics can be used to augment antidepressant therapy for PTSD?

Second-generation: Risperidone, Olanzapine

What is Post-traumatic Stress Disorder (PTSD) characterized by?

Significant distress or impairment in functioning of at least 1 month's duration in response to a traumatic event described as exposure to actual or threatened death, serious injury or sexual violence

Phenelzine may cause hypertensive crisis when used in combination with which drugs?

Sympathomimetic agents, tyramine or levodopa

Does medication taken immediately after a traumatic event prevent the onset of PTSD?

There is little evidence to prove this - Hydrocortisone administered within 6 hours of trauma demonstrated an absolute risk reduction of approximately 13% (23% vs. 10% NNT 7) to prevent one occurrence of PTSD. Future studies are needed.

Should those who are overwhelmed and have impaired functioning be started on psychotherapy or medication within the first 4 weeks of the traumatic event?

Yes