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Chapter 59. Post-Traumatic Stress Disorder

Which selective serotonin reuptake inhibitors (SSRI) is/are approved by the Food and Drug Administration (FDA) for the treatment of post-traumatic stress disorder (PTSD)? Select all that apply.

a. Zoloft

b. Prozac

c. Paxil

d. Celexa

Answers a and c are correct. Zoloft (sertraline) and Paxil (paroxetine) are the only two agents that are FDA-approved for PTSD.

Answers b and d are incorrect. Although Prozac (fluoxetine) and Celexa (citalopram) have shown some benefits in treating this population, they are not FDA-approved for PTSD.

QN is a 43-year-old man with post-traumatic stress disorder (PTSD). He has tried several medications in the past, including sertraline, escitalopram, and venlafaxine; however, he has not experienced significant improvement of symptoms with any of these agents. The physician wants to start alprazolam 1 mg twice daily and asks if this is appropriate. How do you correctly respond to the physician?

a. Alprazolam is not effective in the treatment of PTSD and may worsen symptoms.

b. Alprazolam is effective; however, dose should be started at 0.5 mg twice daily.

c. Alprazolam is effective and dosing is appropriate.

d. Alprazolam is not the most appropriate benzodiazepine to use. It is best to initiate clonazepam 0.5 mg twice daily.

Answer a is correct. Alprazolam is a benzodiazepine, which has not shown efficacy in clinical trials. Recent data show it may worsen symptoms.

Answers b, c, and d are incorrect. Benzodiazepines are not utilized in the management of PTSD.

What is the correct dosing range for sertraline recommended for the treatment of post-traumatic stress disorder (PTSD)?

a. 2 to 8 mg/d

b. 20 to 60 mg/d

c. 50 to 200 mg/d

d. 200 to 800 mg/d

Answer c is correct. The correct dosing range for sertraline is 50 to 200 mg/d.

Answers a, b, and d are incorrect. All other doses are incorrect for sertraline in the treatment for PTSD.

Which agent(s) is/are available in extended-release formulations? Select all that apply.

a. Citalopram

b. Venlafaxine

c. Paroxetine


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