A 28-year-old combat veteran has recurrent intrusive memories of battlefield deaths, nightmares, hypervigilance, emotional numbing, and persistent negative beliefs ('the world is dangerous'). Symptoms began 3 months after returning from deployment. Duration has been 6 months. DSM-5 diagnosis is PTSD. The FIRST-LINE pharmacotherapy is:
- A Sertraline or paroxetine (SSRI — FDA approved for PTSD) ✓
- B Alprazolam 0.5 mg TDS
- C Valproate 500 mg BD
- D Propranolol 40 mg TDS
Correct answer: A. Sertraline or paroxetine (SSRI — FDA approved for PTSD)
Explanation
Sertraline and paroxetine are the only FDA-approved pharmacotherapies for PTSD and are first-line. Venlafaxine (SNRI) is also considered first-line internationally. Benzodiazepines (alprazolam) are contraindicated in PTSD — they worsen long-term outcomes, impair fear extinction, and increase risk of substance dependence in this population. Propranolol has been studied for memory reconsolidation blockade but is not standard 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.