PTSD Pharmacology & Medication Management 2 — Questions and Answers
Question 1: Which antidepressant class has the strongest evidence base and is considered first-line pharmacotherapy for PTSD according to clinical guidelines?
- Tricyclic antidepressants (TCAs)
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Monoamine oxidase inhibitors (MAOIs)
- Benzodiazepines
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs, particularly sertraline and paroxetine, are FDA-approved for PTSD and hold the strongest evidence as first-line pharmacotherapy.
Question 2: A patient with PTSD reports persistent nightmares unresponsive to SSRIs. Which medication is most commonly added as an adjunct specifically targeting trauma nightmares?
- Quetiapine
- Prazosin (Correct answer)
- Buspirone
- Gabapentin
Correct answer: Prazosin
Prazosin, an alpha-1 adrenergic blocker, is widely used as an adjunct to reduce PTSD-related nightmares by blocking norepinephrine-driven arousal during sleep.
Question 3: Why are benzodiazepines generally NOT recommended for PTSD treatment despite their anxiolytic effects?
- They cause irreversible cognitive impairment
- They worsen PTSD symptoms and interfere with fear extinction (Correct answer)
- They are hepatotoxic in PTSD populations
- They reduce serotonin synthesis
Correct answer: They worsen PTSD symptoms and interfere with fear extinction
Benzodiazepines can worsen PTSD outcomes by impairing fear extinction learning and are associated with dependence risk, making them contraindicated in most PTSD guidelines.
Question 4: Venlafaxine, an SNRI, is considered which level of evidence for PTSD pharmacotherapy?
- Experimental only
- Second-line after SSRIs
- Contraindicated
- First-line equal to SSRIs (Correct answer)
Correct answer: First-line equal to SSRIs
Venlafaxine has sufficient evidence to be considered a first-line agent for PTSD alongside SSRIs in multiple international guidelines.
Question 5: A veteran with PTSD is started on sertraline. At what typical timeframe should a clinician assess for meaningful symptom improvement?
- 24-48 hours
- 1 week
- 4-8 weeks (Correct answer)
- 6 months
Correct answer: 4-8 weeks
SSRIs typically require 4-8 weeks at therapeutic doses before meaningful PTSD symptom reduction can be evaluated.
Question 6: Which of the following atypical antipsychotics has been most studied as an augmentation agent for PTSD when SSRIs provide partial response?
- Clozapine
- Risperidone
- Quetiapine (Correct answer)
- Haloperidol
Correct answer: Quetiapine
Quetiapine has the most evidence among atypical antipsychotics as an adjunctive agent for PTSD, particularly for sleep disturbance and residual hyperarousal.
Question 7: A patient with PTSD and comorbid major depression fails two SSRI trials. Which pharmacological approach is most supported by evidence?
- Switch to a TCA
- Trial of an MAOI
- Switch to venlafaxine or add an augmenting agent (Correct answer)
- Initiate long-term benzodiazepine therapy
Correct answer: Switch to venlafaxine or add an augmenting agent
Switching to an SNRI like venlafaxine or augmenting with an atypical antipsychotic represents the most evidence-supported next step after two failed SSRI trials.
PTSD Pharmacology & Medication Management 2
Which antidepressant class has the strongest evidence base and is considered first-line pharmacotherapy for PTSD according to clinical guidelines?