Treatment for posttraumatic stress disorder

OBJECTIVE: To thoroughly and critically review the pharmacologic treatment of posttraumatic stress disorder (PTSD) and to review the symptomatology, d iagnosis, epidemiology, pathophysiology, and assessment of PTSD. DATA SOURCES: A MEDLINE search (1966-October 1999) in the English language specific PTSD drug treatment as the search term was used to identify articl es. STUDY SELECTION AND DATA EXTRACTION: All articles identified were reviewed; emphasised was given to randomized, double-blind placebo-controlled studie s, DATA SYNTHESIS: It appears that a five-week medication trial is necessar y to assess clinical effects on PTSD symptoms. The monoamine oxidase inhibi tors appear to be superior to the tricyclic antidepressants in improving re experiencing and avoidance symptoms. Most studies used assessment tools tha t neglected hyperarousal symptoms; therefore, no conclusions regarding this symptoms cluster can be drawn. Other pharmacotherapeutic interventions rep orted in open-label trials have yielded varying success CONCLUSIONS: The current literature does not bear a sufficient number of do uble-blind, placebo-controlled studied using assessment tools that evaluate the three symptom clusters of PTSD to allow for a definite treatment modal ity to be formulated. Nonetheless, a treatment hierarchy appears to be in o rder based on the greatest number of double-blind, placebo-controlled studi es evaluating antidepressants. Alternate modalities such as mood stabilizer s, antipsychotics, anxiolytics, and adrenergic blockers should not be consi dered the mainstays of therapy.