The Carlat Psychiatry Podcast
PTSD 101: Prazosin or SSRI?
Sep 16, 2024
In this discussion, Kellie Newsome, a PMHNP with expertise in psychiatric care, dives into the pros and cons of SSRIs versus the off-label use of prazosin for PTSD management. The conversation highlights prazosin's effectiveness, especially for nightmares, while critiquing SSRIs for their adverse effects and limited patient satisfaction. Newsome also explores emerging treatments and the importance of personalized care in addressing PTSD symptoms effectively.
18:36
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Quick takeaways
- SSRIs like sertraline and paroxetine, while FDA-approved for PTSD, have significant limitations and side effects that complicate treatment decisions.
- Prazosin emerges as a compelling off-label option for treating PTSD symptoms such as nightmares, despite requiring careful patient monitoring for safety.
Deep dives
Trauma-Informed Medication Approaches
Medication for PTSD is often considered less effective than therapy, yet some patients may prefer or require pharmacological options. The FDA has approved sertraline and paroxetine as treatments for PTSD; however, they exhibit notable limitations. Sertraline has shown efficacy primarily in women with civilian trauma and performed poorly in trials overall, while paroxetine poses significant withdrawal risks and has troubling side effects. An alternative suggested is fluoxetine, which, although off-label, has demonstrated a larger effect size in PTSD studies compared to the FDA-approved SSRIs, thus positioning it as a more favorable option for robust response rates.
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