What are antidepressants?

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have been found to be efficacious in the treatment of depression and anxiety. PTSD was originally classed as an anxiety disorder. Antidepressants may work for PTSD by correcting imbalances in neurotransmitters thought to play a role in causing and/or maintaining symptoms.

What is the evidence on antidepressants for PTSD?

Moderate quality evidence found the antidepressants phenelzine (large effect), desipramine (medium-sized effect), paroxetine, venlafaxine, fluoxetine, and sertraline (all small effects) were more effective for PTSD symptoms than placebo. Phenelzine was more effective for PTSD symptoms than the antidepressants citalopram, bupropion, sertraline, and imipramine. Phenelzine was also more effective than the anticonvulsants divalproex and tiagabine, the alpha blocker prazosin, and the adrenergic receptor agonist guanfacine. Paroxetine and desipramine were more effective for PTSD symptoms than citalopram, divalproex, and prazosin. Venlafaxine and fluoxetine were more effective for PTSD symptoms than citalopram and prazosin. Citalopram was less effective for PTSD symptoms than the antidepressant mirtazapine and the antipsychotic olanzapine. There were fewer dropouts due to adverse events with the antidepressant brofaromine than with the antidepressants sertraline and paroxetine, and the anticonvulsant topiramate.

Moderate to low quality evidence found no differences between paroxetine or sertraline plus prolonged exposure vs. paroxetine, sertraline, or prolonged exposure alone. There were no differences in PTSD relapse rates after discontinuation of antidepressants or placebo. Moderate to high quality evidence found no influence of baseline PTSD symptom severity on efficacy of paroxetine and sertraline after 12 weeks of treatment.

August 2021

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Last updated at: 4:41 am, 15th October 2021
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