PTSD Pharmacological Treatment — MRCPsych Paper B MCQ

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EasyAnxiety & Stress-Related DisordersPTSD Pharmacological TreatmentMRCPsych Paper B

A 40-year-old man has a diagnosis of post-traumatic stress disorder. Despite repeated discussion, he has declined trauma-focused CBT and states that he prefers drug treatment. According to NICE NG116, which pharmacological option should be considered?

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

The correct answer is A. 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 treatment remains preferred, so medication is not described as something that must be offered first. Antipsychotics are reserved as specialist-managed adjuncts when disabling symptoms, such as severe hyperarousal or psychotic symptoms, have not responded to other drug or psychological treatments. Diazepam is not a recommended PTSD treatment and carries dependence and withdrawal risks. Prazosin and pregabalin are not recommended pharmacological options for PTSD in NICE NG116. The original explanation was inaccurate in stating that mirtazapine is an SSRI specifically mentioned by NICE.

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