Post-traumatic stress disorder (PTSD)
NICE NG116: Post-traumatic stress disorder Lothian: Antidepressants - Swapping and Stopping
First line treatment is non-pharmacological measures. Treatment options for anxiety disorders include psychological, and guided self-help approaches as first line. Choice of treatment in individual cases will usually be determined by patient preference, and the severity of the condition.
Initially 25mg daily for 1 week, increased to 50mg daily. If partial response then dose can be increased in 50mg increments at intervals of at least 1 week to 200mg daily maximum.
Initially 25mg daily for 1 week, increased to 50mg daily. If partial response then dose can be increased in 50mg increments at intervals of at least 1 week to 200mg daily maximum.
Initially 25mg daily for 1 week, increased to 50mg daily. If partial response then dose can be increased in 50mg increments at intervals of at least 1 week to 200mg daily maximum.
Prescribing Notes:
- There is evidence that SSRIs are effective for anxiety and related disorders, however the licensed indications are different for each.
- Co-prescribing of a benzodiazepine may be useful for 2-4 weeks during the initiation of an SSRI.
- Due to the risk of withdrawal reactions, cessation of treatment should involve a very gradual downward titration. If intolerable symptoms develop it may be necessary to reinstate the previously prescribed dose and withdraw more gradually. See local protocols for advice.
- Discontinuation of drug treatment may result in recurrence of symptoms. The patient outcome may be improved by use of concurrent psychological therapies.
- Alpha-blockers can be useful for nightmares or flashbacks, however their use is unlicensed.
- SSRIs are associated with an increased risk of bleeding, especially in older people or in people taking other drugs that have the potential to damage the gastrointestinal mucosa or interfere with clotting. Consider prescribing a gastroprotective drug in older people who are taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin.
- SSRIs should be used with caution in patients over 80 years due to the risk of gastro-intestinal bleeding.
- General notes on prescribing in pregnancy are available in the Pregnancy section of the formulary.
History Notes
09/04/2024
Addition of link to general notes on prescribing in pregnancy, ERWG May 24.
27/10/2022
East Region Formulary content agreed.
First line treatment is non-pharmacological measures. Treatment options for anxiety disorders include psychological, and guided self-help approaches as first line. Choice of treatment in individual cases will usually be determined by patient preference, and the severity of the condition.
History Notes
15/01/2024
East Region Formulary content agreed.