The Carlat Psychiatry Podcast PTSD 101: Prazosin or SSRI?
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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.
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Therapy First, Meds Secondary
- Medications are generally less effective than therapy for PTSD, so start with therapy when possible.
- If medication is needed, consider patient preference as it predicts better response.
Prefer Fluoxetine Over Other SSRIs
- If you choose an SSRI for PTSD, fluoxetine may be preferable to sertraline or paroxetine.
- Use fluoxetine 20–40 mg/day and monitor for tolerability and withdrawal risk.
SSRIs Have Limited Benefits
- SSRIs approved for PTSD have limited and inconsistent efficacy, with small effect sizes.
- Paroxetine has more robust data but worse tolerability and pregnancy safety than other SSRIs.