PTSD Medicines: Pharmacological Treatment for Post-Traumatic Stress Disorder

What is PTSD?

PTSD is an anxiety disorder that develops after traumatic events like physical abuse or military combat. Unlike a typical stress reaction that wanes over time, PTSD can become a chronic and debilitating mental health condition.

In many cases, people with PTSD experience flashbacks, feel on edge and lash out in anger. They might blame themselves for the trauma they’ve experienced, have difficulty sleeping, and experience a diminished interest in activities that were once enjoyable.

However, PTSD has many more symptoms and is much more complex than a simple definition can describe. Further information can be found in our guide on PTSD.

Which medications are used to treat PTSD?

While there are many different classes and types of PTSD medicines, only two have Food and Drug Administration (FDA) approval to treat PTSD: sertraline (Zoloft) and paroxetine (Paxil).^[2] 

Yet, other unlicensed medications, like phenelzine (Nardil), nefazodone (Serzone), and imipramine (Tofranil), might be prescribed to treat some PTSD symptoms.^[3] These and other commonly prescribed medications for PTSD are outlined below.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most effective class of PTSD medicines for most patients. PTSD medications like sertraline (Zoloft) and paroxetine (Paxil) help regulate serotonin in the brain, which helps regulate mood, sleep, and appetite. 

Fluoxetine (Prozac) is another type of SSRI that might be prescribed if sertraline or paroxetine doesn’t have the desired effect. It isn’t approved by the FDA to treat PTSD but has shown value as an off-label treatment in clinical trials.^[4][5]

SSRIs come with some side effects of which to be aware. The most common side effects include agitation, indigestion, and loss of appetite. Dry mouth, blurred vision, and dizziness are also common. 

More severe side effects include suicidal ideation, hyponatremia (a reduction in sodium levels), and serotonin syndrome, all of which can be life-threatening.^[6]

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Like SSRIs, SNRIs are antidepressants and are commonly prescribed to treat PTSD symptoms. However, SNRIs like venlafaxine (Effexor) modulate serotonin and norepinephrine to treat core symptoms of PTSD. SNRIs provide a second-line treatment option for PTSD patients should one of the SSRIs listed above not work. 

Venlafaxine has several common side effects, including dizziness, dry mouth, and reduced libido. More severe side effects include chest pain, nose bleeds, and anxiety attacks.

Serotonin Reuptake Inhibitors (SRIs)

Another medication for PTSD is a class of drugs called SRIs. SRIs work by preventing the reuptake of norepinephrine and serotonin in the brain. These drugs, like nefazodone (Serzone), are atypical antidepressants and are not frequently prescribed.

SRIs can be used in conjunction with other medications, which is a benefit, but there are many side effects to consider as well. Common side effects include constipation, dry mouth, and insomnia. Dizziness, blurred vision, and agitation also commonly occur. Dangerous side effects (e.g., hepatotoxicity or liver damage) are also possible.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs operate on an enzyme in the brain responsible for breaking down dopamine, serotonin, and norepinephrine. By inhibiting that action, the number of neurotransmitters in the brain increases, thereby reducing symptoms of PTSD.

However, MAOIs are not as effective as SSRIs or SNRIs as PTSD treatment medication. Likewise, MAOIs like phenelzine (Nardil) have a long list of potential side effects and interactions, such as sleepiness, headache, and hypotension. Severe side effects may include seizures, liver dysfunction, and suicidal ideation.

Tricyclic Antidepressants (TCAs)

TCAs like imipramine (Tofranil) are mood-enhancing drugs acting on chemicals that improve communication between brain cells. As a PTSD medication, it is not nearly as common as SSRIs or SNRIs, mainly because it has far more side effects. 

Mild side effects include headache, nightmares, and drowsiness. Dizziness, nausea, and cramps are also common. 

More severe side effects include: 

• Insomnia
• Eye Pain
• Muscle spasms
• Difficulty breathing
• Seizures

How else can PTSD be treated?

In addition to medication for PTSD, patients can benefit from various therapies or self-help techniques. The American Psychological Association (APA) strongly recommends the treatment options below:^[7]

• Cognitive-behavioral therapy (CBT) - CBT examines how feelings, thoughts, and behaviors are interconnected. It also explores problem behaviors and symptoms and teaches patients how to change their behavioral patterns to improve their functioning.
• Cognitive processing therapy (CPT) - CPT is a type of CBT that targets unhelpful beliefs related to past trauma. Likewise, CPT teaches patients how to address maladaptive thoughts, which in turn helps patients change how they feel.
• Cognitive therapy (CT) - CCT is also related to CBT and seeks to modify unhealthy assessments and memories associated with a traumatic event. The purpose of CT is to disrupt negative behaviors and thought patterns to improve daily functioning.
• Prolonged exposure - This type of CBT gradually introduces patients to their traumatic memories to teach them that their memories don’t pose a danger and therefore don’t need to be avoided any longer.

Additionally, the APA has conditionally recommended the following effective treatments:^[7] 

• Brief eclectic psychotherapy - This type of therapy combines CBT and psychodynamic therapy. Treatment focuses on transforming feelings of guilt and shame while emphasizing the positive relationship between the patient and their therapist.
• Eye movement desensitization and reprocessing (EMDR) therapy - EMDR is a highly structured treatment that focuses on brief experiences with traumatic memories while also experiencing bilateral stimulation, usually in the form of eye movements. This therapy has shown promise for reducing the emotionality and vividness of traumatic memories.
• Narrative exposure therapy (NET) - NET focuses on devising a life narrative that offers context to past traumatic experiences. It is typically employed in a group setting. 

Self-help strategies can be used with medication, therapy, or both to improve functionality and address PTSD symptoms. Common self-help strategies include:^[8]

• Seek support from loved ones
• Inquire about an emotional support animal
• Avoid using alcohol or drugs
• Focus on the present by practicing mindfulness
• Get plenty of rest, maintain a healthy diet, and exercise regularly
• Be realistic about your progress; don’t expect to overcome PTSD overnight 

Above all, seek professional help if you feel you might be a danger to yourself or others or feel that you can no longer manage your PTSD symptoms.