Be Alert for PTSD Linked to the COVID-19 Pandemic

Mental health fallout from the COVID-19 pandemic will put more focus on treating post-traumatic stress disorder (PTSD).

Early data suggest PTSD rates of up to 30% in COVID-19 patients post-hospitalization...and increasing rates in healthcare workers.

Stay alert for people who may be affected by PTSD.

Listen for reports of severe distress due to symptoms such as nightmares, intrusive memories, or guardedness.

Share resources to help find treatment options...such as calling 800-662-HELP (4357) or using the Crisis Text Line at 741741.

Explain that PTSD treatment is similar regardless of the cause.

First, recommend psychotherapy that focuses on the trauma. This generally helps PTSD symptoms more than meds...and benefits last longer.

If psychotherapy isn't feasible or enough, weigh med options.

Think of fluoxetine or paroxetine as the most effective meds for PTSD...but weigh side effects, such as weight gain with paroxetine. Sertraline seems slightly less effective...but it's often well tolerated.

Consider venlafaxine as another option...but withdrawal symptoms seem more likely when stopping it or paroxetine.

With any of these, suggest starting low and titrating. High doses may be needed...such as fluoxetine 60 to 80 mg/day. Ensure an adequate trial at a max dose for about 8 weeks before evaluating whether to switch.

Advise treating for at least 6 to 12 months if there's benefit...and expect to individualize decisions about longer durations.

Recommend tapering the antidepressant if stopping.

Evidence for prazosin in PTSD is mixed. Generally save it for patients with nightmares or sleep issues despite other treatment.

Reserve antipsychotics for when psychotherapy and first-line meds aren't enough...or for patients with a mood disorder or other indication. Data with these meds are limited for PTSD.

Steer clear of benzodiazepines. There's no evidence they help most PTSD symptoms...and they may impair recovery.

Use our chart, Pharmacotherapy of PTSD, for guidance about antiseizure meds, cannabinoids, mirtazapine, and more.

Key References

  • JAMA Psychiatry 2021;78(5):567-9
  • Curr Psychiatry Rep 2021;23(2):9
  • Am Fam Physician 2019;99(9):577-83
  • www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf (5-21-21)
  • J Psychiatr Res 2020;130:412-20
Pharmacist's Letter. June 2021, No. 370606



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