22nd February 2024

Management

Non- pharmacological therapies 

• Exposure therapy: the patient is encouraged to remember and describe the traumatic event. By doing so, they repeatedly encounter the trauma that they have been avoiding and which has been causing them distress. 
• Trauma-focused cognitive therapy: helps the patient identify misconceptions and thoughts that are associated with a particular trauma, helping them confront and overcome the things that elicit fear and distress. 
• Eye movement desensitisation and reprocessing (EMDR). An effective therapy where the patient is encouraged to describe or reimagine the original trauma in detail. Whilst doing this, their therapist will move their finger / an object from side to side and patients are encouraged to follow the movement of the stimuli with their eyes. The repetitive movement of the eyes is thought to stimulate the brain and helps with reprogramming the patients’ traumatic memories and the negative emotions attached to them. 

Pharmacological therapies:

These are commenced in patients who have not responded to psychological therapies, who do not want to engage in psychological therapies or who cannot undergo psychological therapies yet due to ongoing trauma. It is also started in combination with other therapies, particularly in those with co-morbid depression.  

• SSRIs: Firstline, for example, Fluoxetine, Paroxetine and Sertraline. 
• SNRIs: Venlafaxine is thought to reduce PTSD symptoms and improve functionality. Used in those who don’t tolerate SSRIs.
• Atypical Antipsychotics: If the above fail, Quetiapine and Risperidone are recommended
• TCA: Amitriptyline or mirtazapine can be used as a last resort if the other drug therapies are ineffective 

If drug therapy is successful, it should be continued for at least 12 months.