PTSD Treatment Guidelines

Introduction to PTSD Treatment

• The American College of Physicians recommends initiating trauma-focused psychotherapy, such as cognitive processing therapy, prolonged exposure, or EMDR, as first-line treatment for PTSD, and using SSRIs or venlafaxine as pharmacotherapy when psychotherapy is unavailable or as adjunctive treatment 1, 2

First-Line Treatment Options

• Trauma-focused psychotherapy, including cognitive processing therapy, prolonged exposure therapy, and EMDR, are equally effective and should be offered immediately without mandatory stabilization phases 1, 2, 3
• Expected outcomes of trauma-focused psychotherapy include 40-87% of patients no longer meeting PTSD criteria after 9-15 sessions 5

Pharmacotherapy

• SSRIs, such as fluoxetine, paroxetine, or sertraline, and SNRIs, such as venlafaxine, are recommended as first-line medications for PTSD 1
• Prazosin is recommended for PTSD-related nightmares, starting at 1 mg at bedtime and increasing by 1-2 mg every few days until effective 4

Treatment Delivery and Monitoring

• Secure video teleconferencing can be used to deliver recommended psychotherapy when validated for this modality or when in-person options are unavailable 1
• Video or computerized interventions produce similar effect sizes to in-person treatment and improve access 5
• Anticipate relapse after medication discontinuation, with 26-52% of patients relapsing when shifted from sertraline to placebo, and consider longer-term medication treatment 5, 6

Critical Pitfalls to Avoid

• Avoid benzodiazepines entirely, as 63% of patients receiving benzodiazepines developed PTSD at 6 months versus only 23% receiving placebo 5, 6
• Do not recommend cannabis or cannabis-derived products for PTSD treatment 1, 2
• Never provide psychological debriefing within 24-72 hours after trauma, as this may be harmful 4, 5