PTSD: National Center for PTSD
PTSD Guideline Overview - Rural Provider PTSD Toolkit
Rural Provider PTSD Toolkit
Shared Decision MakingShared decision making is an approach in which providers and patients communicate together using the best available evidence to make decisions.
To learn more, take this PTSD 101 online course: Shared Decision Making for PTSD.
DiagnosisAn accurate diagnosis and assessment using either a clinical interview or structured diagnostic interview is an essential first step to correctly identify patients with PTSD and ensure they receive appropriate treatment. Brief questionnaires such as the PTSD Checklist (PCL-5) can be used to assess symptom severity and monitor treatment response.
PTSD Treatment GuidelinesA major change in the 2017 guideline is there is now a recommendation to use specific trauma-focused treatments over medications or other psychotherapies, which are both recommended as second line.
The guideline's recommendation to use individual trauma-focused psychotherapy over pharmacotherapy reflects the current state of research into PTSD treatment. Two recent meta-analyses noted that trauma-focused psychotherapies impart greater change with regard to core PTSD symptoms than pharmacotherapies, and that these improvements persist for longer time periods.19, 20 The trauma-focused psychotherapies with the strongest evidence from clinical trials are:
- Prolonged Exposure (PE)
- Cognitive Processing Therapy (CPT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Specific cognitive behavioral therapies (CBTs) for PTSD
- Brief Exposure Therapy (BEP)
- Narrative Exposure Therapy (NET)
- Written Narrative Exposure
- Stress Inoculation Training (SIT)
- Present-Centered Therapy (PCT)
- Interpersonal Therapy (IPT)
For those patients who choose not to engage in or are unable to access trauma-focused psychotherapy and opt for medication treatment, the use of the specific antidepressants as monotherapy is recommended:
- Sertraline (ZoloftÂ®)
- Paroxetine (PaxilÂ®)
- Fluoxetine (ProzacÂ®)
- Venlafaxine (EffexorÂ®)
- Atypical antipsychotics
- Memory impairment
- Withdrawal symptoms
- Impaired coordination
- Car accidents, falls, fractures
- Worse talk therapy outcomes
- Anxiety, irritability, anger
- Negative respiratory outcomes
- Reproductive risk
- All cause + unintentional overdose mortality
- Movement disorders, akathisia
- Anticholinergic effects
- Psychiatric effects
- Apathy, withdrawal
- Orthostatic hypotension
- Metabolic effects
- Weight gain, hyperglycemia, diabetes, dyslipidemia
- Reproductive risk
- Sudden cardiac death, arrhythmia
There is another large group of medications where the evidence is insufficient to recommend for or against their use. A significant change in the revised 2017 guideline is seen regarding the use of prazosin. The current recommendation suggests against prazosin for global symptoms of PTSD based on lack of efficacy and insufficient evidence to recommend as mono- or augmentation therapy for nightmares.
Despite considerable interest in alternatives to either psychotherapy or medication for the treatment of PTSD, there is currently insufficient evidence to recommend the majority of somatic therapies or complementary and integrative treatments including any animal-assisted therapy.