Treatment of Anxiety and Mood Symptoms

Non-Stimulant Medication Options

The American Academy of Child and Adolescent Psychiatry suggests that non-stimulant options, such as Atomoxetine, may be preferable for patients with comorbidities, with an effect size of approximately 0.7, compared to 1.0 for stimulants 1
Extended-release guanfacine or extended-release clonidine may also be considered, with effect sizes of approximately 0.7, as recommended by the American Academy of Child and Adolescent Psychiatry 1

The American College of Physicians recommends avoiding cannabis and cannabis-derived products for PTSD treatment, due to lack of evidence supporting their effectiveness 2
Benzodiazepines are not recommended due to their potential to worsen outcomes in PTSD and high abuse potential, especially in patients with AUD, as stated in the Journal of Hepatology 3

The British Journal of Psychiatry recommends trauma-focused cognitive-behavioral therapy (CBT) as first-line treatment for acute PTSD, while chronic PTSD may require a broader range of evidence-based treatments including trauma-focused CBT and additional pharmacological interventions when CBT is not tolerated 4
Trauma-focused psychotherapy is strongly recommended as the first-line treatment for persistent symptoms of PTSD, with significantly superior outcomes compared to medication alone, as supported by the American Psychiatric Association 5, 6, 7, 2
Cognitive Behavioral Therapy (CBT), including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR), is particularly effective for addressing symptoms of PTSD, as supported by research 8, 9, 6

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (50-200 mg/day) and paroxetine (20-60 mg/day), are first-line pharmacological treatments for PTSD, with 53-85% of participants classified as treatment responders 6, 10, 11
Prazosin is strongly recommended (Level A evidence) for PTSD-related nightmares, with a starting dose of 1 mg at bedtime, gradually increased to effective dose (average 3 mg, range 1-15 mg), and patients should be monitored for orthostatic hypotension, as recommended by the American Academy of Sleep Medicine 10
Clonidine may be considered for PTSD-associated nightmares (Level C evidence) with dosing of 0.2-0.6 mg in divided doses, and patients should be monitored for blood pressure changes, as recommended by the American Academy of Sleep Medicine 10

Promoting social support networks is associated with better PTSD outcomes, as recommended by the British Journal of Psychiatry guidelines 4
Lifestyle modifications, including sodium restriction (<1500 mg/day), increased potassium intake (3500-5000 mg/day), weight management, physical activity (90-150 min/week of aerobic or resistance exercise), alcohol moderation (≤2 drinks/day for men, ≤1 drink/day for women), and a DASH-like diet rich in fruits, vegetables, whole grains, and low-fat dairy, are recommended by the American Heart Association 12
Family engagement is crucial for treatment success, including educating family about PTSD and self-harm, addressing dysfunctional family patterns, and providing psychoeducational materials about mood disorders and treatments, according to the American Academy of Child and Adolescent Psychiatry 13
A trauma-informed approach with caregivers, recognizing potential trauma histories, assessing for stressors related to social determinants of health, and assuming caregivers love their children and are doing their best, is also important, as reported in Pediatrics 14

Assessment of persistent symptoms should focus on symptom clusters and functional impairment, including daily activities, social relationships, occupational functioning, and overall quality of life, as recommended by the American Academy of Pediatrics 8
Adjustment disorder, acute stress disorder, other trauma-related disorders, major depressive disorder, anxiety disorders, and substance-induced disorders should be considered in the differential diagnosis of PTSD, as they may have similar symptoms or symptom profiles 15
Refer to specialized mental health services when symptoms persist despite initial treatment attempts, symptoms cause significant distress or functional impairment, there are comorbid conditions (depression, substance use, etc.), or there is risk of self-harm or suicide, as recommended by general mental health guidelines 8
Delays in accessing appropriate care can worsen symptoms and lead to chronicity, emphasizing the need for timely and effective treatment, although the specific guideline society is not specified in the provided text 8

Early intervention (within 90 days of trauma) shows small to moderate effect sizes in preventing PTSD development, according to the Depression and Anxiety journal 5
CBT delivered within hours to weeks after trauma exposure demonstrates effectiveness in preventing chronic PTSD, as reported by the Depression and Anxiety journal 5
Early intervention can prevent progression to chronic PTSD, as reported by the Depression and Anxiety journal 5