Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can occur after trauma, a threat, or a life threatening event. There are several medications that can help relieve the symptoms of PTSD.

Fear is a normal response to a shocking or traumatic situation. Some people may continue to experience anxiety or fear following the event. The anxiety or fear may alter their behavior, even after the perceived threat has passed. Sometimes these symptoms arise months or even years after the event.

A medical or mental health professional can diagnose PTSD. A person must experience symptoms for at least 1 month for a PTSD diagnosis to be made. Medications and talk therapy are first-line treatments.

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There are four kinds of medications that treat PTSD. However, only two of them currently have approval from the Food and Drug Administration (FDA) specifically to treat the condition. All four medications are antidepressants that act on the levels of neurotransmitters in the brain.

The FDA-approved medications for PTSD are sertraline (Zoloft) and paroxetine (Paxil). The other two medications are fluoxetine (Prozac) and venlafaxine (Effexor).

A doctor or psychiatrist can determine which medication is the best option and make adjustments based on the body’s response.

All medications currently available for treating PTSD are prescription medications. They are either part of a class of medications called selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs).

Serotonin and norepinephrine are neurotransmitters. These brain chemicals directly affect mood. Neurotransmitters pass between nerve cells to carry messages around the brain.

After transmitting the message, neurotransmitters reabsorb into nerve cells, a process called reuptake. SSRIs and SNRIs prevent reuptake, allowing more neurotransmitters to flow in the brain.

Brain chemistry is complex, so this explanation is simplified, but healthcare professionals know that affecting neurotransmitter levels can help relieve symptoms of PTSD.

Sertraline is an SSRI that comes in tablet and liquid form.

How to take

People usually take sertraline once daily in the morning or at night.

People should not take sertraline with monoamine oxidase inhibitors (MAOIs). A person should let their doctor know about any other medications or supplements they are taking. For example, taking St. John’s wort or tryptophan can interact with sertraline and cause complications.

Dosage

Sertraline treats PTSD with a daily dose of 50–200 milligrams (mg). A doctor may prescribe a smaller dose to begin treatment and increase it slowly as needed.

Side effects

Sertraline may cause drowsiness. People taking this medication need to be cautious about driving or operating machinery while initially starting the medication.

Side effects could include:

  • gastrointestinal symptoms
  • dry mouth
  • weight changes
  • dizziness
  • fatigue
  • headache
  • nervousness
  • shaking
  • sexual dysfunction

A person should alert a doctor immediately if any of these side effects occur:

  • seizures
  • bleeding or bruising
  • agitation
  • hallucinations
  • confusion
  • loss of coordination
  • fever
  • fast heart rate
  • headache
  • weakness
  • unsteadiness
  • memory problems
  • rash
  • hives
  • swelling
  • difficulty breathing

Some people under the age of 25 who took sertraline in clinical trials experienced suicidal thoughts or ideation. Even adults might have unexpected changes in mood or emotions after starting SSRIs.

The prescribing doctor will want to follow up often during the early treatment. A person taking this medication should notify the doctor of any concerning changes or side effects.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Paroxetine is an SSRI that comes in tablet, capsule, and liquid form.

How to take

People typically take paroxetine once per day, usually at bedtime. Taking paroxetine with food may help prevent an upset stomach.

Doctors generally prescribe the tablet form of paroxetine, not the capsules, to treat mental health conditions. The capsules contain a lower dose of the medication than necessary.

Dosage

Paroxetine treats PTSD with a daily dose of 20–60 mg. The doctor may prescribe a smaller dose to begin treatment and increase it slowly as a person requires.

Side effects

People should not take paroxetine with MAOIs. Doctors do not recommend paroxetine for people over 65. There are other medications for PTSD a doctor may choose instead.

Side effects of paroxetine include:

  • headache
  • dizziness
  • problems concentrating
  • confusion
  • gastrointestinal issues
  • appetite loss
  • weight changes
  • sexual dysfunction
  • joint pain or swelling

People taking the medication who have any of the following side effects should call their doctor immediately:

  • hallucinations
  • fainting
  • irregular heartbeat
  • chest pain
  • problems breathing
  • seizures
  • bleeding or bruising
  • tiny red spots under skin
  • numbness or tingling
  • black and tarry or bloody stools
  • bloody vomit, or vomit that looks like coffee grounds

Some people under the age of 25 who took paroxetine in clinical trials experienced suicide ideation. People of any age may have unexpected changes in mood or emotions when taking SSRIs.

A doctor will want to follow up often during the early treatment. People should notify their doctor of any concerning changes or side effects.

Fluoxetine is an SSRI that comes as a tablet, capsule, delayed-release capsule, and liquid.

How to take

The tablet, capsules, and liquid are usually taken once in the morning or twice a day (once in the morning and once at midday). The delayed-release capsules are usually taken once per week.

Dosage

Fluoxetine treats PTSD with a daily dose of 20–80 mg. A doctor may prescribe a smaller dose to begin treatment and increase it slowly as needed.

Interactions and side effects

People should avoid taking fluoxetine with MAOIs. A person seeking treatment should let their doctor know if they or anyone in the family has or has ever had an irregular heart rhythm called a prolonged QT interval.

A person should also alert their doctor if they:

  • have low potassium levels
  • low magnesium levels
  • have low sodium levels
  • are receiving treatment with electroshock therapy

People should discuss any health problem with the doctor before beginning fluoxetine.

Fluoxetine can cause drowsiness. Alcohol can exacerbate these effects. People need to use caution when driving or operating machinery when taking this medication.

Side effects may include:

  • nervousness
  • anxiety
  • difficulty sleeping
  • diarrhea
  • heartburn
  • loss of appetite
  • weight loss
  • unusual dreams
  • sexual dysfunction
  • headache
  • confusion
  • weakness
  • difficulty concentrating
  • memory problems

People should contact their doctor immediately if any of these side effects occur:

  • joint pain
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • problems breathing or swallowing
  • nausea, vomiting, or diarrhea
  • irregular heartbeat
  • shortness of breath
  • dizziness or fainting
  • seizures
  • abnormal bleeding or bruising

Some people under the age of 25 who took fluoxetine in clinical trials experienced suicidal thoughts or ideation.

Even adults over 25 years and older might have unexpected changes in mood or emotions after starting SSRIs. A person should notify their doctor of any concerning side effects.

Venlafaxine is an SNRI that comes as a tablet or extended-release capsule.

How to take

Doctors typically recommend people take the tablets two to three times per day with food.

Dosage

Venlafaxine treats PTSD with a daily dose of 75–300 mg. A doctor may prescribe a smaller dose to begin treatment and increase it over time.

Side effects and risks

People should not take venlafaxine with MAOIs. They should let their doctor know about any other medications or supplements they take, including tryptophan, St. John’s wort, or any recreational drugs.

If a person is taking venlafaxine and is awaiting surgery, they should let the surgeon know they are taking this medication.

Venlafaxine may cause drowsiness. Alcohol may exacerbate the effects. People taking this medication need to be cautious about driving or operating machinery while starting this medication.

Venlafaxine can cause high blood pressure. People should have their blood pressure monitored regularly.

Side effects may include:

  • dizziness
  • headache
  • nightmares
  • loss of appetite
  • weight loss
  • pain, burning sensations, or numbness
  • hot flashes or flushing
  • problems urinating
  • chills
  • ringing in the ears
  • sexual dysfunction
  • enlarged pupil(s)

People should contact their doctor immediately if any of the following side effects occur:

  • problems breathing or swallowing
  • chest pain
  • irregular heartbeat
  • seizures
  • unusual bruising or bleeding
  • problems with coordination or motor functions
  • hallucinations
  • coma

There are some specific things a doctor or mental health professional will look for if they are considering a diagnosis of PTSD. A person must have experienced all the following for at least 1 month to receive a PTSD diagnosis:

  • at least one re-experiencing symptom
  • at least one avoidance symptom
  • at least two arousal and reactivity symptoms
  • at least two cognition and mood symptoms

Symptoms of re-experiencing might include flashbacks, bad dreams, or scary thoughts. These may disrupt sleep or a person’s daily routine.

Avoidance symptoms might include avoiding people, places, or events that are reminders of the trauma. Alternatively, the person might try to ignore or look past thoughts and feelings that occur about the trauma.

Arousal and reactivity symptoms are feelings of stress and anxiety. They might include:

  • feeling startled
  • feeling tense
  • problems sleeping
  • anger problems

There may be other ways these symptoms manifest. Cognition and mood symptoms can present in many ways. A few examples include:

  • problems remembering the trauma
  • negative thoughts about self or life
  • feelings of guilt or blame
  • loss of interest in normal activities

PTSD symptoms can take weeks, months, or years after a traumatic event to appear. PTSD often occurs alongside another mood disorder or substance misuse.

Although medication is a common treatment for PTSD, it is not the only one. Other options include:

Talk therapy

There are different types of therapy to help people with PTSD process trauma and reframe their thinking and emotions attached to the traumatic event.

Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are both types of therapy that have been found to have success in treating PTSD.

The therapist may ask the person to talk through the trauma while assisting them in managing feelings of anxiety or discomfort. Reframing the experience in a safe and supportive environment can relieve physical and emotional symptoms.

Talk therapy often takes place alongside medication treatment.

Other medications

If PTSD symptoms are preventing a person from accomplishing daily activities or working, a doctor may prescribe certain medications to assist the antidepressants, such as:

  • antianxiety medication
  • mood stabilizers
  • alpha-1 blockers

Alpha-1 blockers work by reducing the fight-or-flight response. They can help with nightmares and sleep problems as well.

Feeling the first symptoms of PTSD can be a disarming experience, but there are medications that can help, such as SSRIs and SNRIs.

Treatment with SSRIs and SNRIs should begin slowly, and people should monitor side effects. The prescribing doctor will want regular check-ins during the first few weeks. The doctor may recommend talk therapy or other medications alongside antidepressant treatment.

It is normal to feel some residual fear and anxiety following a traumatic event. PTSD occurs when a person experiences debilitating anxiety and fear related to the event for an ongoing period of time, at least 1 month.

There are currently four medications commonly prescribed to treat PTSD, although only two of them are FDA-approved for that purpose. Sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are SSRIs. Venlafaxine (Effexor) is an SNRI.

All antidepressants come with possible side effects, so a doctor may prescribe a lower dose to start and increase the dose over time. They will want to check in regularly, particularly at the beginning of treatment, to monitor side effects and the effectiveness of the medication.