PTSD is a common mental health condition that affects civilians as well as military personnel. Any form of mental or physical trauma can produce PTSD. Examples include dangerous combat situations, rape or other assaults, serious automobile accidents, and many others.
Treatment is essential but can be challenging. Fortunately, there are multiple forms of psychotherapy that have been shown to be effective. Examples include Cognitive Behavioral Therapy , Narrative Exposure Therapy, Prolonged Exposure, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing Therapy (EMDR), and others.
Sometimes therapy is unavailable or not sufficient for treatment. The FDA has approved two SSRI-type antidepressant medications (sertraline and paroxetine) for treatment. However, 40% of patients do not benefit.
Research has demonstrated that combining sertraline (brand name Zoloft) with brexpiprazole (brand name Rexulti) works better than sertraline alone. After being on these two medications for 10 weeks, there is a clear benefit from combining these two medications.
Brexpiprazole is in a class of medications called antipsychotics. It is unique in that it affects 3 transmitters in the brain instead of just one. It is called an antipsychotic because that was what is was first used for. PTSD is NOT a psychosis.
It is important for everyone to understand that many medications are categorized based on their first use. However, over time, they may be found to benefit many other conditions that may be completely unrelated to the initial use.
A good example is aspirin. It can be used to treat fever, pain, prevent heart attacks and strokes, and relieve inflammation in certain conditions. These are all different medical conditions that can benefit from the same medication (typically, at different doses).
Medication alone is not recommended for PTSD. The combination of medication and psychotherapy is best.
Most of the information for this blog comes from a review article by Samantha Anderer in JAMA Online January 17, 2025.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
