A 32-year-old man who survived a building collapse 6 months ago presents with flashbacks of the event, nightmares, emotional numbness, avoidance of construction sites, and exaggerated startle response. He reports feeling detached from others and is unable to experience positive emotions. He has not been able to return to work. What is the first-line pharmacotherapy for this condition?
- A Sertraline ✓
- B Alprazolam
- C Haloperidol
- D Buspirone
Correct answer: A. Sertraline
Explanation
Post-traumatic stress disorder (PTSD) first-line pharmacotherapy consists of SSRIs — sertraline and paroxetine are the only FDA-approved medications. SNRIs (especially venlafaxine) are considered second-line. Benzodiazepines like alprazolam are generally avoided in PTSD because they may impair fear extinction learning and worsen long-term outcomes, and they carry addiction risk. Prazosin (an alpha-1 blocker) has evidence for PTSD-related nightmares. Trauma-focused CBT is the preferred first-line overall treatment.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.