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Effective Management Strategies for Posttraumatic Stress Disorder

From the Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.

Correspondence: Address correspondence to Dr. Davidson, Director, Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Trent Drive, Fourth Floor, Yellow 4082B, Box 3812, Durham, NC 27710; jonathan.davidson{at}duke.edu, e-mail.

Although the diagnostic features of posttraumatic stress disorder (PTSD) are well defined, the condition is not always easy to recognize; in studies in primary care settings, recognition rates as low as 2% have been reported. Somatization and comorbid disorders are more likely to serve as presenting features, including substance abuse, depression, and suicide attempts. Education, support, and stress reduction techniques are all important elements in the management of PTSD. Exposure and cognitive restructuring have proven efficacy and are associated with low relapse rates. Although eye movement desensitization and reprocessing is widely used, it is inferior to conventional types of prolonged exposure or cognitive therapy. Treatment with antidepressants produces a broad array of benefits and is associated with relapse prevention when medication is maintained for at least 1 year; ending medication early is associated with a fivefold increase in the risk of relapse. Full remission can occur with use of an SSRI and exposure-based treatments. Less is known about the efficacy of other drug groups, such as anticonvulsants and antipsychotics, but they are widely considered to be important second-line treatments. Benzodiazepines are of limited use and may even be detrimental when given alone. Current controversies include the question of treating acute PTSD, or acute stress disorder, as well as whether onset of symptoms can be prevented through treatment immediately after trauma.

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