Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy

Recent evidence suggests that an etiologia model of posttraumatic stress di sorder (PTSD) must include both vulnerability factors (presumably related t o dysregulation of stress responses and/or failure of normal restitutive me chanisms following trauma) and factors related to trauma severity. The fact that rates of PTSD increase with the severity of trauma suggests that norm al adaptive mechanisms may become overwhelmed even in the absence of vulner ability factors. Consistent with this view, efforts to demarcate normative from disordered reactions to severe trauma, such as the new diagnosis of ac ute stress disorder, have had limited success. Debate over the moral and sc ientific implications of receiving a trauma-related diagnosis has further c omplicated the issue and perpetuated a false dichotomy concerning normative responses. The literature on clinical trials in PTSD is reviewed. The rang e of treatment responses, and the categorical breadth of compounds studied, requires interpretation before the literature as a whole can be understood . One of the many limitations of this new literature is the absence of trea tment-outcomes research on individuals with the common comorbidity of subst ance abuse. The most recent findings with selective serotonin-reuptake inhi bitors and related compounds indicate a more optimistic outlook for pharmac ological treatment of PTSD than was suggested by earlier trials. Given thes e observations, investigators will hopefully be encouraged to pursue study and development of treatment models that include both pharmacological and p sychosocial interventions.