Medication Summary
Current research indicates that SSRIs prazosin and propranolol may be helpful in the treatment of posttraumatic stress disorder (PTSD). Benzodiazepines are often used but present significant risks especially to the elderly, individuals with co-morbid substance abuse histories, and traumatic brain injury.
Beta-Adrenergic Blocking Agents
Class Summary
Beta blockers inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic stimulation.
Propranolol (Inderal LA, InnoPran XL, Hemangeol)
Propranolol may be useful for the treatment of hyperarousal.
Selective Serotonin Reuptake Inhibitors
Class Summary
SSRIs are first-line agents for managing anxiety, depression, avoidance behavior, and intrusive recollections. They are antidepressant agents that are chemically unrelated to tricyclic, tetracyclic, or other available antidepressants. SSRIs inhibit central nervous system (CNS) neuronal uptake of serotonin (5HT). They may also have a weak effect on norepinephrine and dopamine neuronal reuptake.
Citalopram (Celexa)
Citalopram enhances serotonin activity through selective reuptake inhibition at the neuronal membrane. It is the least activating of the SSRIs and is particularly useful in ASD. The incidence of adverse effects (especially sexual) is less than with other SSRIs.
Escitalopram (Lexapro)
Escitalopram is the S-enantiomer of citalopram. It may have a faster onset of depression relief (1-2 weeks) in comparison with other antidepressants.
Sertraline (Zoloft)
Sertraline selectively inhibits presynaptic serotonin reuptake with minimal or no effect on the reuptake of norepinephrine or dopamine.
Benzodiazepines
Class Summary
Benzodiazepines bind to a specific receptor on the gamma amino-butyric acid (GABA) receptor complex, thereby increasing the affinity of GABA for its receptor. They also increase the frequency of chlorine channel opening in response to GABA binding. GABA receptors are chlorine channels that mediate postsynaptic inhibition, resulting in postsynaptic neuron hyperpolarization. The final result is a sedative-hypnotic and anxiolytic effect.
Alpha-Adrenergic Agonists
Class Summary
The centrally acting alpha2 -adrenergic agonists clonidine and guanfacine have been used to treat children with attention deficit hyperactivity disorder (ADHD). Inhibition of norepinephrine release in the brain may be its mechanism of action.
Antihistamines, Sedating
Class Summary
Older, sedating antihistamines (eg, diphenhydramine) are often prescribed as sedatives because of their CNS-depressing properties.
Tables
Malignant Schemata |
Constructive Schemata |
Life has no meaning |
Right now it is hard to make sense of what happened |
I can’t go on |
What happened is very painful; dealing with it is hard but will get easier over time |
I behaved terribly |
I was frightened and unsure what to do and made some bad choices |
The world is unsafe |
Disasters are rare, and many things can be done to protect my safety |
I’m losing my mind |
Feeling confused and overwhelmed after a traumatic experience is common |
It was my fault it happened |
What was done to me was a crime |
