Treatment of posttraumatic stress disorder (PTSD)

The present review summarises recommendations for the management of posttraumatic stress disorder (PTSD) based on a consensus among international experts in the field. Cognitive-behavioural therapy (CBT) has the best evidence base as a psychotherapy modality. Virtual reality exposure therapy appears to be an emerging treatment option for PTSD. Eye Movement Desensitisation and Reprocessing (EMDR) therapy and digital CBT-based interventions did not demonstrate superiority compared to controls. Controlled studies supporting the use of psychodynamic therapy are lacking. Early prophylactic psychotherapy for trauma victims is ineffective and may be harmful. First-line pharmacotherapy includes selective serotonin reuptake inhibitors (SSRIs) and the serotonin-noradrenaline reuptake inhibitor (SNRI) venlafaxine. Several second- and third-line medications are available for treatment-refractory patients. Currently, no medications can be recommended for prophylactic use in trauma victims. Although evidence is incomplete regarding combined psychotherapy and pharmacotherapy, available studies generally favour combination treatments over monotherapy. Repetitive transcranial magnetic stimulation (rTMS) showed efficacy in one study. In children and adolescents with PTSD, CBT demonstrated a medium effect size compared to active controls, while studies on SSRI treatment in this population yielded inconsistent results.