The results of meta-analyses for individual drugs, which had been tested against placebo in at least two RCTs showed statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.
NICE, in their clinical guideline on the management of PTSD (2005), recommend the following in terms of pharmacological therapy for adults:
• Drug treatments (paroxetine or mirtazapine for general use, and amitriptyline or phenelzine for initiation only by mental health specialists) should be considered for the treatment of PTSD in adults where a sufferer expresses a preference not to engage in a trauma-focused psychological treatment.
• Drug treatments (paroxetine or mirtazapine for general use and amitriptyline or phenelzine for initiation only by mental health specialists) should be offered to adult PTSD sufferers who cannot start a psychological therapy because of serious ongoing threat of further trauma (for example, where there is ongoing domestic violence).
• Drug treatments (paroxetine or mirtazapine for general use and amitriptyline or phenelzine for initiation only by mental health specialists) should be considered for adult PTSD sufferers who have gained little or no benefit from a course of trauma-focused psychological treatment.
• Where sleep is a major problem for an adult PTSD sufferer, hypnotic medication may be appropriate for short-term use but, if longer-term drug treatment is required, consideration should also be given to the use of suitable antidepressants at an early stage in order to reduce the later risk of dependence.
• Drug treatments (paroxetine or mirtazapine for general use and amitriptyline or phenelzine for initiation only by mental health specialists) for PTSD should be considered as an adjunct to psychological treatment in adults where there is significant comorbid depression or severe hyperarousal that significantly impacts on a sufferer's ability to benefit from psychological treatment[2].
• If further drug treatment is considered, this should generally be with a different class of antidepressant or involve the use of adjunctive olanzapine.
Paroxetine and sertraline are the only two drugs currently licensed for the treatment of post-traumatic stress disorder.