Pharmacotherapy for PTSD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersPharmacotherapy for PTSDMRCPsych Paper B

A 45-year-old veteran with combat-related post-traumatic stress disorder has completed two adequate courses of trauma-focused CBT but continues to experience severe flashbacks and nightmares. Following discussion of the benefits and risks, he states that he would prefer drug treatment. According to NICE NG116, which pharmacological intervention should be considered and reviewed regularly?

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Correct answer: D — An SSRI such as sertraline, or venlafaxine

NICE recommends considering venlafaxine or an SSRI, such as sertraline, for an adult with PTSD who prefers drug treatment; treatment should be reviewed regularly. Trauma-focused psychological therapy remains the preferred first-line approach, but this patient has completed appropriate therapy and now expresses a preference for medication. Antipsychotics are not recommended as monotherapy: specialist-prescribed adjunctive treatment may be considered only for disabling symptoms, such as severe hyperarousal or psychotic symptoms, that have not responded to other drug or psychological treatments. Long-term benzodiazepines carry dependence and other harms and are not the recommended PTSD pharmacotherapy. NICE NG116 does not recommend pregabalin or cannabis-based medicinal products for treating PTSD.

Reference: National Institute for Health and Care Excellence. Post-traumatic stress disorder (NG116), recommendations 1.6.25–1.6.26: Drug treatments for adults. 2018, amended 2024. https://www.nice.org.uk/guidance/ng116/chapter/recommendations