The Carlat Psychiatry Podcast PTSD 101: Nine Off-Label Meds
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Sep 23, 2024 Delve into the intriguing world of off-label medications for PTSD, with a spotlight on a new contender awaiting FDA approval. Discover promising advances in antipsychotic treatments like Brexpiprazole and its partnership with sertraline. The conversation also tackles the complexities of treating insomnia tied to PTSD, weighing the pros and cons of medications like trazodone and benzodiazepines. Personalization in treatment is emphasized as crucial for effective management.
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Therapy First, Meds Second
- Medications are secondary to therapy in PTSD because therapy yields larger short- and long-term benefits.
- Medication choice should be personalized based on dominant symptoms like insomnia or nightmares.
Use Topiramate Cautiously And Titrate Slowly
- Consider topiramate for treatment-resistant PTSD or PTSD with alcohol use disorder, but expect variable tolerability.
- Start low and titrate slowly, watching for cognitive and sensory side effects.
Limit Antipsychotic Augmentation
- Reserve antipsychotic augmentation for severe, treatment-resistant PTSD and avoid using them solely for sleep.
- Rispiridone has best evidence historically, but brexpiprazole may become a new option soon.