Abstract

PHARMACOTHERAPY OF POST-TRAUMATIC STRESS DISORDER

Saracheva K.*, Vasileva L. and Getova D.

Abstract

Post-Traumatic Stress Disorder is a serious psychological disorder caused by an unexpected shocking event, such as sexual assault, warfare, serious injury or threat. However, being exposed to a traumatic experience does not automatically mean that a person will develop PTSD. It can be divided in two types. Type 1 results from a single trauma. Type 2 results from protracted and recurring trauma. PTSD is a pleomorphic disorder with symptoms in multiple domains (headache, pain, etc.) and perhaps for this reason (among others) combination treatments seem to be the standard in clinical practice. Effective treatments include both pharmacologic and psychosocial management. The principal goals of pharmacotherapy for PTSD should aim at 1) reducing core PTSD symptoms in all three clusters (re-experience, avoidance and numbing and increased arousal); 2) reducing functional impairment and disability; 3) improving life quality; 4) improving resilience to stress or trauma; 5) reducing co-morbidity such as depression, other anxiety disorders and substance abuse; 6) preventing relapse; and 7) preventing the development of PTSD in candidates who are at high risk of non-recovery after a trauma. Our review aimed to evaluate the available scientific data for pharmacological treatment in PTSD. Most studies involve antidepressants: selective serotonin reuptake inhibitors (SSRIs), selective noradrenalin reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and other serotonergic agents (trazodone and nefazodone). Antiadrenergic drugs tested include alpha-2 receptor agonists (clonidine and guanfacine) and the beta-receptor antagonist (propranolol). Other drugs tested include benzodiazepine, anxiolytics, antipsychotic agents and triptans for headache relief.

Keywords: PTSD, treatment, options.