The Role(s) of Psychopharmacology in the Treatment of PTSD

Posttraumatic stress disorder (PTSD) is a chronic psychiatric disorder which results in decreased quality of life and impaired occupational and social functioning. The only two medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD are sertraline and paroxetine, both Selective serotonin reuptake inhibitors (SSRIs). Unfortunately, limited efficacy of these and other psychotropics used off-label, commonly leads to the use of multiple medications that still fail to achieve remission. Several trauma-focused psychotherapies have been identified as having the strongest evidence for treating PTSD, but these too can be limited by low levels of access as well as reduced rates of patient engagement and retention. A number of studies evaluating other medications have failed to develop any robust or effective pharmacologic intervention. Thus, there is a great need to find new approaches to psychopharmacological treatment for PTSD. Recent advances have improved our understanding of the underlying pathophysiology of PTSD and have led to evaluation of several different psychopharmacological agents with effects on glutamatergic, cannabinoid, opioid, and oxytocin systems—many of which have shown promise despite contrasting mechanisms being studied. Recent research specifically evaluating strategies to identify and manipulate target systems involved in fear extinction are intriguing. However, the preponderance of evidence showing limitations in the medication only approach combined with the promise of remission possible through trauma-focused therapy, leads to the suggestion that medication-related enhancement of psychotherapy may be the most practical and an effective approach to assure that resources achieve the best possible outcome.