Antipsychotics, anticonvulsants, antiadrenergic agents and other drugs: What to do when posttraumatic stress disorder does not respond to selective serotonin reuptake inhibitors?

Abstract

Objectives: In this narrative review, we aimed to describe different pharmacological strategies for the treatment of patients with posttraumatic stress disorder who display different levels of intolerance, resistance, and refractoriness to the treatment, or who are unable to take to antidepressants, especially serotonin reuptake inhibitors. Method: We searched the ISI Web of Science and PubMed databases for original studies focusing on the treatment of posttraumatic stress disorder in different clinical scenarios. Results: Preliminary evidence pointed towards the efficacy of drugs such as risperidone, olanzapine, lamotrigine and prazosin as strategies to be employed in the above mentioned clinical scenarios. The choice of a specific "second line" drug should take into account not only symptoms, but also patterns of comorbidities, previous response to other treatments, pharmacological interactions, side-effects, and the patient's physical conditions. Conclusions: Future randomized controlled trials should be performed in order to unveil which drugs should be prescribed in the absence of adequate treatment and response to serotonin reuptake inhibitors.