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Adult Posttraumatic Stress Disorder
Adult Posttraumatic Stress Disorder
Diagnosis
Medication
Recommendation
Does the patient suffer from clinically significant hallucinations?
Yes
No
Does the patient suffer from any sleep disturbances?
Yes
No
X
Yes
No
Yes
Partial response
Adequate
response
Moderate to
high risk
Yes
Inadequate
response
No
No
Partial response
Partial
response
Inadequate
response
Posttraumatic Stress Disorder
Sleep disturbance
present?
Sleep initiation
problem
Trazodone
TCA
Mirtazapine
Hydroxyzine
Midsleep wakening/
nightmares
Prazosin
SOR B
Remaining PTSD symptoms
present?
Monitor for reemergence of
PTSD symptoms
SSRI/SNRI
SOR A
Follow up and titrate dose
as appropriate q 1-2 weeks for active
medication management
Evaluate for
Augmentation
(only augment
SSRIs, SNRIs, and
Mirtazapine)
Mixed evidence for antipsychotic
augmentation (SOR B)
Hyperarousal
symptoms
Clonidine
Guanfacine
Propranolol
Alternatively consider:
Quetiapine
Avoidance
symptoms
Lamotrigine
Alternatively consider:
Aripiprazole
Re-experiencing
symptoms
Lamotrigine
Alternatively consider:
Aripiprazole
Risperidone
Quetiapine
Maintenance Therapy
minimum 6 - 12 months
1. Sertraline or Venlafaxine
2. Paroxetine
Screen for Obstructive
Sleep Apnea
Polysomnography
Trauma focused psychotherapy
(Based on availability and patient preference)
SOR A
Psychiatric
comorbidites present?
See corresponding
Decision Support Tool
Clinically significant
hallucinations
Consider evaluation
for psychiatric
hospitalization
Try alternative SSRI/SNRI
Not previously trialed
1. Sertraline or Venlafaxine
2. Paroxetine
Psychiatric consultation if available
Recommend:
Prolonged Exposure
CPT
CBT
Consider:
EMDR
CT
NET
BEP
Alternatively consider
Brief Written Exposure
in primary care settings
Third
choice
TCA
SOR B
Desipramine
Amitriptyline
Imipramine
Mirtazapine
SSRIs:
Escitalopram
Citalopram
Fluoxetine
Paroxetine
Atypical Antipsychotic
SOR B
Psychiatric consultation if available
Aripiprazole
Quetiapine
Risperidone
SSRI and atypical
antipsychotic
Risperidone
Quetiapine
Aripiprazole