4.3.2.3 Post-traumatic stress disorder

ChoiceDrugDosage
1st choiceNon-pharmacological treatment
2nd choicesFluoxetine 20mg capsules, 20mg/5ml oral liquid [unlicensed indication]

Dose:
20mg once daily; if inadequate response after 2 weeks increase gradually to max 60mg once daily
(elderly usual max 40mg once daily but 60mg can be used)

Or
Mirtazepine tablets 15mg, 30mg, 45mg [unlicensed indication]Dose:
Initially 15-30mg daily at bedtime, increased within 2-4 weeks according to response; max 45 mg daily as a single dose at bedtime or in 2 divided doses

Prescribing Notes

  • See NICE guidance 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.
  • 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.
  • Paroxetine is licensed for PTSD, however, the risk of withdrawal reactions is higher with paroxetine. Patients taking paroxetine should not stop the drug suddenly. Cessation of treatment should involve a very gradual downward titration. If intolerable symptoms develop it may be necessary to reinstate the previously prescribed dose and withdraw more gradually.

Cautions

See cautions here.