Which pharmacologic treatments are commonly used for PTSD, and what cautions apply?

• A. MAOIs; haloperidol for all symptoms.
• B. SSRIs/SNRIs; prazosin for nightmares; benzodiazepines are generally avoided due to dependence risk.
• C. Only antipsychotics with sedative effects.
• D. Beta blockers only.

Answer: (B)

The main idea is that PTSD is commonly treated with specific medications that address core symptoms and sleep-related disturbances, along with important cautions about certain drug classes. The evidence-based approach uses SSRIs or SNRIs as first-line pharmacotherapy because they help reduce intrusive memories, avoidance, negative mood, and hyperarousal over several weeks. For sleep problems and distressing nightmares often seen in PTSD, prazosin is used; it can decrease nightmare frequency by blocking alpha-1 receptors, but it requires careful monitoring of blood pressure due to the risk of orthostatic hypotension. Benzodiazepines are not preferred for PTSD because of the risk of dependence and withdrawal, potential sedation and cognitive dulling, and the possibility that they can interfere with psychotherapy or worsen overall outcomes. In practice, this combination—SSRI/SNRI as a base, prazosin for nightmares, and avoiding benzodiazepines for long-term treatment—reflects the standard approach and cautions in managing PTSD pharmacotherapy.