Medication for post-traumatic stress disorder

Photo of a traumatized woman being comforted
PantherMedia / Dmitriy Shironosov

Although medication can’t replace psychological treatment, it can be a valuable addition in certain situations. But only a few medications have been proven to work. Because they may have side effects, it’s a good idea to carefully consider the pros and cons before deciding whether or not to use them.

Psychological support is the most important treatment for post-traumatic stress disorder (PTSD). Scientific guidelines advise people not to only use medication. Medication is only considered in certain situations. The decision will depend on factors such as the type and severity of symptoms and whether the person has other illnesses such as depression, an anxiety disorder or an addiction.

Medication can be taken for the following purposes:

  • Temporary relief of severe symptoms such as insomnia or panic attacks
  • Long-term relief of PTSD symptoms

Antidepressants, sleeping pills and sedatives () are the most commonly used medications in the treatment of PTSD. Benzodiazepines aren’t suitable for the treatment of PTSD, though, because there’s a risk of becoming dependent on them and they hardly relieve the symptoms.

Before starting treatment with medication, it’s important to find out how effective it is and what side effects it may have. You should also talk to your doctor about what can be expected from the treatment, and then have regular appointments to discuss how well the medication is working and how to deal with any problems that arise. It’s important for the doctors and psychologists who are treating you to share information about your treatment. Psychologists aren’t allowed to prescribe medication.

Antidepressants

Antidepressants are usually only considered for the treatment of PTSD if the person is feeling very depressed, anxious or irritable. They are also meant to help people fall asleep and stay asleep. Antidepressants can be used temporarily or for long-term treatment. Only two medications have been approved for the treatment of post-traumatic stress disorder in Germany: the antidepressants sertraline and paroxetine. Both of these drugs have been shown to relieve the symptoms in scientific studies. A number of other antidepressants can be used too, but only “off label.” It often takes several weeks for antidepressants to start working.

In studies, the symptoms clearly improved within a few months in about

  • 35 out of 100 people who didn’t take antidepressants, and in about
  • 55 out of 100 people who did take antidepressants.

In other words, antidepressants clearly helped in about 20 out of 100 people.

A lot of people who have PTSD are also able to manage without antidepressants. Because this medication can have side effects such as headaches, dizziness or nausea, it’s important to carefully consider whether you really need to take it.

Sleeping pills and sedatives

Sleeping pills and sedatives are meant to reduce hyperarousal (e.g. feeling anxious, irritable and on edge) and improve sleep. But scientific guidelines now advise people who have PTSD not to use them. Hardly any studies have looked into their effectiveness. What’s more, you can become dependent on them within just a few weeks.

Can PTSD be prevented with medication?

Medication is rarely taken for the prevention of PTSD: It generally can’t stop the development of post-traumatic stress disorder if you start taking it immediately after the traumatic event. The only medication that has been shown to reduce the risk of PTSD, in several studies, is hydrocortisone. This drug was mainly given to hospital patients immediately after major surgery or to hospital patients who had blood poisoning (septicemia). PTSD was less common in these patients. It is thought that some people are more likely to develop post-traumatic stress disorder because their body doesn’t produce enough cortisol in stressful situations. Hydrocortisone makes up for this.

Amos T, Stein DJ, Ipser JC. Pharmacological interventions for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2014; (7): CD006239.

Deutschsprachige Gesellschaft für Psychotraumatologie (DeGPT). S3 - Leitlinie: Posttraumatische Belastungsstörung. AWMF-Registernr.: 051-010. January 31, 2011.

Frommberger U, Nyberg E, Angenendt J, Lieb K, Berger M. Posttraumatische Belastungsstörungen. In: Berger M (Ed). Psychische Erkrankungen - Klinik und Therapie. München: Urban und Fischer; 2015.

Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry 2015; 206(2): 93-100.

Lee DJ, Schnitzlein CW, Wolf JP, Vythilingam M, Rasmusson AM, Hoge CW. Psychotherapy Versus Pharmacotherapy for Posttraumatic Stress Disorder: Systemic Review and Meta-Analyses to Determine First-Line Treatments. Depress Anxiety 2016; 33(9): 792-806.

Shalev A, Liberzon I, Marmar C. Post-Traumatic Stress Disorder. N Engl J Med 2017; 376(25): 2459-2469.

Sijbrandij M, Kleiboer A, Bisson JI, Barbui C, Cuijpers P. Pharmacological prevention of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis. Lancet Psychiatry 2015; 2(5): 413-421.

Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2006; (1): CD002795.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Created on October 4, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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