Post-traumatic Stress Disorder (PTSD)
Exposure to life-threatening trauma
Nightmares, flashblacks, intrusive memories
Avoidance of reminders, dissociation
Emotional detachment, negative mood, decreased interest in activities
Sleep disturbance, hypervigilance, exaggerated startle response, irritability
Duration >= 1 month
First-line treatment options:
Antidepressants (SSRIs and SNRIs)
SSRIs like paroxetine
Although anxiety and severe insomnia are common PTSD symptoms, benzodiazepines like lorazepam are not effective in PTSD (especially in patients with comorbid substance use disorder).
If the patient is using stimulants to counter insomnia (such as caffeine), advise the patient to taper use in conjunction with PTSD treatment.
Early treatment of PTSD may prevent the development of chronic functional impairment.
Benzodiazepines can be used to provide rapid relief of panic attacks and can also be used in the short-term while waiting for a SSRI to take effect. Benzos, however, should be prescribed cautiously in patients with a history of substance use disorder.