A 35-year-old combat veteran has intrusive memories of an ambush, nightmares, emotional numbing, avoidance of crowded places, hypervigilance, and sleep disturbance for 8 months after returning home. Which pharmacotherapy is FDA-approved and recommended as first-line for PTSD?

• A Alprazolam
• B Haloperidol
• C Propranolol
• D Sertraline or paroxetine (SSRIs) ✓

Explanation

Sertraline and paroxetine are the only FDA-approved pharmacological treatments for PTSD. Both are SSRIs and are first-line pharmacotherapy. Trauma-focused psychotherapy (Prolonged Exposure, Cognitive Processing Therapy, or EMDR) is the first-line overall treatment. Benzodiazepines (alprazolam) are contraindicated or not recommended in PTSD as they may impair fear extinction, worsen depression, and carry addiction risk. Prazosin (alpha-1 blocker) has evidence for PTSD-related nightmares. Propranolol has not shown efficacy in established PTSD.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.