APPROPRIATE HEALTH CARE
• Most treatment is done on an outpatient basis
• Suicidal or dysfunctional with activities of daily living patients should be considered for a hospital-based
intensive treatment program
GENERAL MEASURES
• As indicated by the patient’s general condition, treatment includes individual psychotherapy, group therapy,
hypnotherapy, narcoanalysis and narcosynthesis, and behavior therapy
• Crisis intervention shortly after the traumatic event is very valuable for the immediate distress and may prevent the development of a chronic or delayed form of PTSD
• Relaxation exercises
• Eye movement desensitization and reprocessing (EMDR) may help in some cases
ACTIVITY
• As indicated by patient’s physical condition
• Restoration of regular sleep is essential in cases of insomnia
DIET A healthy diet of complex carbohydrates, proteins, and multivitamins and minerals. Avoid fatty foods.
DRUG(S) OF CHOICE
. Serotonin reuptake inhibitors (SRI):
. Fluoxetine 20-80 mg/day
. Sertraline 50-200 mg/day
. Paroxetine 20-60 mg/day
. Citalopram 20-60 mg/day
. Escitalopram 10-20 mg/day
. NRI/SRI (dual action drug)
. Venlafaxine 75-325 mg/day
. Duloxetine 30-60 mg/day
. TCAs:
. Doxepin 50-150 mg/day
. Nortriptyline 30-100 mg/day
. Imipramine 50-300 mg/day
. Desipramine 50-300 mg/day
. Amitriptyline 50-300 mg/day
. Trimipramine 50-300 mg/day
. Protriptyline 15-60 mg/ day
. Amoxapine 50-300 mg/day
. Maprotiline 50-225 mg/day (increased risk of seizures with higher doses)
. MOAIs:
. Phenelzine 45-75 mg/day is useful in PTSD patients with panic attacks
. Others:
. Trazodone 100-400 mg/day, given mostly at bedtime in patients with insomnia
. Bupropion 100-450 mg/day
. Mirzatzepine 14-45 mg/day
. Neuroleptics - small doses are helpful in selective patients
. Benzodiazepines should be used selectively and with caution
ALTERNATIVE DRUGS
• Clomipramine 75-250 mg/day or fl uvoxamine 100-300 mg/day or fl uoxetine 20-80 mg/day in patients with
obsessive compulsive symptoms has been helpful in some cases
• Buspirone 30-80 mg/day has been found helpful in cases with severe anxiety
• Propranolol and clonidine have been used with limited results to control the psychophysiological hyperactivity
during intense flashbacks
• Mirtazapine (Remeron) 15-45 mg given at bed time has been helpful in patients with insomnia, poor appetite
and weight loss
• Prazosin (Minipress) for nightmares
PATIENT MONITORING Psychotherapy for at least one hour per week is necessary in the first phase of treatment
PREVENTION/AVOIDANCE Crisis intervention immediately after the traumatic event may prevent the development of chronic PTSD
POSSIBLE COMPLICATIONS Alcohol and substance abuse, depression, suicide, self-inflicted violence and reenactment of trauma
EXPECTED COURSE/PROGNOSIS
• The lack of crisis intervention immediately following the trauma may lead to the persistence of symptoms.
If symptoms last less than 3 months, the patient is still in the acute form of PTSD. If symptoms persist over 3
months, patients may develop chronic PTSD which may lead to loss of job, marital confl icts, total disability and repeated and/or lengthy hospitalizations with severe morbidity.
• If the onset of symptoms is at least 6 months or more after the original traumatic event, the patient suffers
from a delayed onset type
• The more chronic and delayed the onset, the worse the prognosis. Early treatment in acute phase Associated with better prognosis.