4.3.2.3 Post-traumatic stress disorder


Choice	Drug	Dosage
1st choice	Non-pharmacological treatment
2nd choices	Sertraline 50mg, 100mg tablets	Dose: Initially 25mg daily for 1 week, then increased to 50mg daily, then increased in steps of 50mg at intervals of at least 1 week if required, increase only if response is partial and if drug is tolerated; max 200mg per day
		Or
		Venlafaxine MR tablets 75mg, 150mg, 225mg; capsules 75mg, 150mg, 225mg [unlicensed]	Dose: Initially 75mg once daily, increased if necessary up to 225mg once daily. Dose to be increased at intervals of at least 2 weeks; maximum 225mg per day

See NICE NG116 Post-traumatic stress disorder
Trauma focused psychological therapy is the first line treatment for PTSD. Choice of treatment in individual cases will usually be determined by patient preference, service availability and the severity of the condition. Evidence on the pharmacological treatment of PTSD is limited
Before starting antidepressants refer to NICE NG215 for information that should be considered and discussed with the patient, including steps to reduce the risk of dependence or withdrawal symptoms
Response to SSRIs is usually seen within 8 weeks, but can take up to 12 weeks. Treatment should be continued for at least six months and probably longer
Antipsychotics such as risperidone can be considered for patients with disabling symptoms and behaviours that have not responded to other drug or psychological treatments. Antipsychotic treatment should be started and reviewed regularly by a specialist