[특집] 외상 후 스트레스 장애의 약물치료

Pharmaeotherapy of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is relatively common and chronic illness that causes severe functional impairment. Though many studies have been done, PTSD is still difficult to understand because of heterogeneity of its nature and other psychiatric comorbidities. But the last decades have brought new appreciation for the complexity and the diversity of clinical features and improved treatment approaches. Achieving complete remission from PTSD through pharmacotherapy alone appears out of reach currently. Antidepressants appear to demonstrate the best overall efficacy for the treatment of PTSD, especially in patients with combined depression, insomnia, intrusive and hyperarousal symptoms. Though data for different efficacy among antidepressants are not known, tricyclic antidepressants and monoamine oxidase inhibitor appear to be effective in severe war PTSD patients and SSRIs appear to be more effective in avoidance/numbness symptoms. Considering their ease of use and tolerability, it is reasonable to choose SSRIs such as paroxetine and sertraline as a first-line treatment. Mood stabilizers are effective, especially for impulsivity, irritability and unstable mood. More studies are needed to confirm the efficacy of benzodiazepine, though it is used for inosmnia, panic symptoms and anxiety. Though there is little empirical date demonstrating the efficacy of antipsychotics, they may provide effective strategy if psychotics symptoms are combined. The future of therapy for PTSD holds much hope with the rapid development of psychopharmacology and elucidation of pathophysiology of PTSD.