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Pharmacotherapy
The use of pharmacologic agents to treat psychiatric illness has increased dramatically since the advent in the 1950s of chlorpromazine, an antipsychotic drug widely regarded as the first psychotropic medication. Interest in the medication-based treatment of trauma-related disorders such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) has grown as those disorders have been more formally characterized and increasingly recognized. A variety of psychotropic agents have been studied both to prevent and treat trauma-related disorders. Certain medications, especially selective serotonin reuptake inhibitors (SSRIs), have shown efficacy in the treatment of noncombat PTSD. Unfortunately, useful preventive pharmacologic interventions and effective treatment for combat-related PTSD remain more elusive. Pharmacologic agents are a mainstay in the treatment of other psychiatric conditions that are also common in the posttrauma period, including depression and substance use disorders. The combined use of medication and psychotherapy has not been adequately studied. However, present evidence and clinical consensus suggest that despite advances in pharma-cotherapy, psychotherapeutic interventions remain an important component of posttraumatic intervention.
Prevention
It has been hypothesized that pharmacologic intervention in the immediate aftermath of a traumatic event may avert the development of both short-term ASD and longer-term PTSD. However, there is little solid evidence that peritraumatic medication is helpful in preventing these disorders. In small studies, beta-adrenergic blockers administered in the wake of a trauma have reduced some symptoms but have not been proven to prevent PTSD. In the event of physical injury, adequate pain control in the acute settings may reduce the likelihood or severity of later PTSD. Benzodiazepines may also improve short-term anxiety and insomnia but have not been demonstrated to be efficacious in treating PTSD. Some evidence suggests that short-term use of benzodiaz-epines around the time of the traumatic event may increase later rates of PTSD. Current guidelines do not recommend any pharmacologic intervention to prevent ASD or PTSD.
Treatment of Acute Stress Disorder
By definition, ASD is a time-limited disorder (if symptoms persist beyond 1 month, PTSD is diagnosed), and treatment for shorter-lived ASD has been less researched than has that for PTSD. The research that has been conducted supports similar treatment as for patients with PTSD—the use of SSRIs and other antidepressants (see later), not a surprising finding given the symptom overlap of the two diagnoses.
Treatment of Posttraumatic Stress Disorder
Antidepressant Medications
SSRIs have been extensively studied for the treatment of PTSD, and their use is considered first-line treatment for the disorder. Two SSRIs, sertraline and paroxetine, have U.S. Food and Drug Administration (FDA) approval for the treatment of PTSD. Clinical guidelines cite four reasons for the primary use of SSRIs to treat PTSD: (1) They ameliorate all three PTSD symptoms clusters (reexperiencing, avoidance/numbing, and hyperarousal); (2) they are effective treatments for psychiatric disorders that are frequently comorbid with PTSD including depression and other anxiety disorders; (3) they may reduce problematic clinical symptoms such as suicidal, impulsive, or aggressive behaviors; and (4) they are relatively well tolerated with few side effects. Multiple studies demonstrated the superiority of SSRIs over placebos in the treatment of noncombat PTSD. SSRIs have also been shown to prevent relapse of PTSD symptoms. In one study, patients who had previously achieved remission of symptoms on fluoxetine were randomized to continue fluoxetine or switch to a placebo. Relapse rates were 22% for fluoxetine compared with 50% with placebos.
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- Anthropology and Archaeology
- Anthropology and Trauma
- Anthropology and War
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Arts and Humanities
- Business and Economics
- Children and Families
- Abduction/Kidnapping
- African Women and Girls' Trauma
- Campus Violence
- Childhood and Adolescent Trauma: An Overview
- Childhood and Adolescent Trauma: Assessment and Treatment
- Childhood Trauma and the Juvenile Justice System
- Childhood Traumatic Stress
- Children of War
- Critical Illness in Children
- Dissociative Identity Disorder and Trauma
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Genetic Epidemiology
- Incest
- Marital Rape
- Marriage and the Marital Relationship
- Military Families, Effects of Combat and Deployment on
- Parenting During and After Traumatic Events
- Perinatal Trauma
- Perinatal Trauma, Long-Term Consequences of
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Resilient Posttraumatic Adjustment in Childhood and Beyond
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- School Shootings
- Systemic Trauma Research
- Transgenerational Transmission of Trauma
- Crime and Law
- Abduction/Kidnapping
- Battered Women
- Blaming the Victim
- Campus Violence
- Childhood Trauma and the Juvenile Justice System
- Clergy, Sexual Abuse by
- Community Violence
- Comstock Act
- Correctional Officers and Trauma
- Crime Scene Investigation
- Criminal Behavior Consequent to War
- Date Rape/Acquaintance Rape
- Genocide
- Genocide in Non-Western Nations
- Genocide, Cambodia's Mass Casualty Trauma
- Hate Crimes
- Homicide and Trauma
- Human Trafficking
- Incarceration and Trauma
- Incest
- Law Enforcement Officers
- Lawsuits Against Behavioral Health Professionals
- Lawsuits Against Medical Professionals
- Male Rape
- Marital Rape
- Mass Violence
- Military Sexual Abuse
- Murder
- Perpetrators of Trauma
- Psychological Injury and Law
- Rapist Profiles
- School Shootings
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
- Sexual Assault and Trauma
- Sexual Assault, Drug Facilitated
- Sexual Compulsion and Trauma
- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
- Slavery and Forced Servitude
- Social Learning Theory and Sexual Aggression
- Survival and Coping After Rape
- Terrorism, History of
- Trauma and Domestic Violence
- Wartime Rape
- Workplace Violence
- Crisis and Disaster
- Community Disasters
- Critical Incident Stress
- Debriefing
- Disaster Medicine
- Disaster Mortuary Services
- Disaster-Related Trauma
- Disasters, History of
- Early Interventions
- Emergency Care and Services
- First Responders and Trauma
- Humanitarian Missions
- Peacekeeping Missions
- Psychobiology of Crisis
- Psychological First Aid
- Psychological First Aid for Older Adults
- Psychospiritual Impact of Disaster
- Resilience and Hurricane Katrina
- Role of Media in Managing Disasters
- Culture and Ethnicity
- African American Culture and Trauma
- African Women and Girls' Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Cultural Beliefs
- Culture and Trauma
- Ethnicity, Culture, and Disaster Response
- Genocide
- Genocide in Non-Western Nations
- Genocide, Cambodia's Mass Casualty Trauma
- Nongovernmental Organizations, Governments, and Humanitarian Aid
- Race-Based Traumatic Stress
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Racism-Induced Trauma
- Refugees
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- Slavery and Forced Servitude
- Traumatization in the Name of Religion
- Death and Dying
- Ethics and Philosophy
- Assisted Suicide
- Boundaries and Boundary Violations
- Boundary Issues for Traumatologists
- Counterbalancing Stress
- Countertransference
- Ethical Dilemmas in Treatment of Trauma
- Ethics
- Humor and Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Philosophy of Trauma Nursing
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Trauma Among Chaplains
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
- Secondary Trauma Among Medical Professionals
- Secondary Trauma Among Medics and Corpsmen
- Secondary Traumatic Stress
- Shame
- Trauma Caregivers
- Trauma Memories: Research and Ethics
- First Responders
- History
- Humanitarian Aid
- Internet, the Media, and Entertainment
- Medicine
- Abortion
- Alcohol and Trauma
- Assisted Suicide
- Brain and Trauma
- Combat Medics and Corpsmen
- Critical Illness in Children
- Disaster Medicine
- Lawsuits Against Medical Professionals
- Medical Marijuana and Posttraumatic Stress Disorder
- Medical Trauma Research
- Pain
- Perinatal Trauma
- Perinatal Trauma, Long-Term Consequences of
- Pharmacotherapy
- Philosophy of Trauma Nursing
- Primary Care
- Psychopharmacology, Psychiatry, and Trauma
- Public Health
- Retraumatization
- Secondary Trauma Among Medical Professionals
- Sexual Assault, Drug Facilitated
- Somatic Complaints
- Trauma-Related Physical Symptoms and Illnesses
- Traumatized Nurses
- Traumatized Physicians
- Natural Sciences
- Biological Effects of Physical and Psychological Trauma
- Biological Mechanism of Traumatic Stress Response
- Biology and Posttraumatic Stress Disorder
- Brain and Memory
- Brain and Trauma
- Encoding Trauma, Neurobiology of
- Genetic Epidemiology
- Hippocampus
- Limbic System
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Psychobiology of Crisis
- Trauma and Metabolic Syndrome
- Trauma Resilience, Ecology of
- Traumatic Inventions and the Ethics of Scientific Discovery
- Traumatized Scientists
- Psychology and Psychiatry
- Acute Stress Disorder
- Biological Mechanism of Traumatic Stress Response
- Brain and Memory
- Burnout
- Clinical Trauma Psychology
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Cognitive Restructuring and Trauma
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Compassion Fatigue
- Complex Trauma
- Conservation of Resources Theory
- Counseling and Education About Trauma
- Counterbalancing Stress
- Countertransference
- Dissociation
- Dissociative Identity Disorder and Trauma
- Evidence-Based Practice
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Fragility, Posttraumatic
- Iatrogenic Effects
- Lawsuits Against Behavioral Health Professionals
- Limbic System
- Marriage and the Marital Relationship
- Meditation
- Memory Work
- Military Psychology and Combat Stress Injuries
- Mowrer's Two-Factor Theory
- Pain
- Personality Disorders
- Pharmacotherapy
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Primary Care
- Promoting Resilience in the Traumatized
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Psychological Injury and Law
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychopharmacology, Psychiatry, and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
- Resilience Bolstering
- Resilience, Growth, and Thriving
- Retraumatization
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Traumatic Stress
- Shame
- Social Learning Theory and Sexual Aggression
- Social Support and Trauma
- Somatic Complaints
- Stigma
- Stress Inoculation Training
- Suicide
- Survival and Coping After Rape
- Systemic Trauma Research
- Theories of Psychological Stress
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma Assessment
- Trauma Education
- Trauma Prevention
- Trauma Psychology Research
- Trauma Triggers
- Trauma-Related Happiness and Pleasure
- Trauma-Related Physical Symptoms and Illnesses
- Trauma, Causes of
- Trauma, Identity, and the Workplace
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Practitioners, Supervisors of
- Victim, Survivor, Thriver
- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- Public Health
- Religion and Spirituality
- Clergy, Counseling by
- Clergy, Sexual Abuse by
- Combat Chaplains
- Cults and Sects
- Growth, Posttraumatic
- Meditation
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Psychospiritual Impact of Disaster
- Religious and Pastoral Responses to Trauma
- Religious Fundamentalism
- Secondary Trauma Among Chaplains
- Spiritual and Religious Growth
- Spiritual Intelligence and Posttraumatic Growth
- Traumatization in the Name of Religion
- Social Work
- Battered Women
- Bereavement
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Comstock Act
- Ethics
- Evidence-Based Practice
- Military Social Work and Combat Stress Management
- Social Support and Trauma
- Social Work With the Traumatized Homeless
- Theories of Psychological Stress
- Trauma and Domestic Violence
- Trauma and Homelessness
- Trauma and Social Work Practice
- Trauma Research, Social Work Contributions to
- Traumatized Practitioners, Supervisors of
- Sociology
- Traumatology and Trauma Recovery
- Acute Stress Disorder
- Additive Trauma
- Alcohol and Trauma
- Bearing Witness to Trauma
- Biology and Posttraumatic Stress Disorder
- Clergy, Counseling by
- Clinical Trauma Psychology
- Cognitive Restructuring and Trauma
- Compassion Fatigue
- Complex Trauma
- Conspiracy of Silence
- Counseling and Education About Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Trauma
- Cumulative Trauma
- Dance and Trauma
- Despair, Posttraumatic
- Disaster-Related Trauma
- Early Interventions
- Encoding Trauma, Neurobiology of
- Ethical Dilemmas in Treatment of Trauma
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Fear, Posttraumatic
- Fragility, Posttraumatic
- Grief and Mourning
- Grief, Complicated
- Growth, Posttraumatic
- Hippocampus
- Homicide and Trauma
- Humor and Trauma
- Hypnosis in the Treatment of Posttraumatic Stress Disorder
- Iatrogenic Effects
- Incarceration and Trauma
- Literary Expressions of Trauma
- Managing Trauma Symptoms
- Medical Marijuana and Posttraumatic Stress Disorder
- Medical Trauma Research
- Military Trauma
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Perpetrators of Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Poetry and Trauma
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Posttraumatic Stress Disorder, History of
- Prolonged Exposure
- Promoting Resilience in the Traumatized
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Rapist Profiles
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
- Resilience and Hurricane Katrina
- Resilience Bolstering
- Resilience, Growth, and Thriving
- Sanctuary Model
- Self-Regulation
- Sexual Compulsion and Trauma
- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
- Shared Trauma
- Silencing Response
- Stigma
- Suicide
- Transgenerational Transmission of Trauma
- Trauma and Autobiography
- Trauma and Homelessness
- Trauma and Metabolic Syndrome
- Trauma and Metaphor
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma and Social Work Practice
- Trauma as Entertainment
- Trauma Assessment
- Trauma Caregivers
- Trauma Education
- Trauma Memories: Research and Ethics
- Trauma Prevention
- Trauma Psychology Research
- Trauma Survival Strategies
- Trauma Triggers
- Trauma-Organized Systems
- Trauma-Related Happiness and Pleasure
- Trauma, Causes of
- Trauma, Definitions of
- Traumatic Bereavement
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Scientists
- Traumatology
- Vicarious Trauma
- Victim, Survivor, Thriver
- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- War Crimes
- War and Combat
- Anthropology and War
- Children of War
- Combat Chaplains
- Combat Medics and Corpsmen
- Combat Mortuary Services
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Combat-Related Stress Injury: Theory, Research, and Management
- Criminal Behavior Consequent to War
- Death Notification in War
- Military Families, Effects of Combat and Deployment on
- Military Psychology and Combat Stress Injuries
- Military Sexual Abuse
- Military Social Work and Combat Stress Management
- Military Trauma
- Secondary Trauma Among Medics and Corpsmen
- War Crimes
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Wartime Rape
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