[Three paradigms in the treatment of posttraumatic stress disorder].
There are three different approaches in the pharmacological treatment of posttraumatic stress disorder (PTSD) in the published data. The most frequently implemented approach is to treat patients suffering from the diagnosis of PTSD. Both short-term acute and long-term relapse prevention treatments represent a curative paradigm: with an intention to diminish the symptoms associated with the disorder. Data about efficacy of monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (SSRIs) in the treatment of PTSD are heterogeneous. Data are relatively consistent with regards of efficacy of SSRIs in the treatment of civilian, predominantly female population, regardless of the type of trauma: interpersonal or non-interpersonal trauma. Placebo controlled trial data in the treatment of combat-related PTSD are inconclusive or negative. Three recently published studies provide new approaches to the treatment of male patients, suffering from combat-related PTSD. A relatively young, recently traumatized male, combat-related population showed significant improvement for fluoxetine compared to placebo. An adjuvant 5HT2 antagonist profile may improve the SSRI effect in the treatment of PTSD: nefazodone was significantly superior compared to placebo in the treatment of combat-related PTSD, and risperidone treatment add-on to antidepressants showed significant benefits compared to antidepressant monotherapy in the treatment of combat-related PTSD. The goal of sedative paradigm is to minimize the immediate consequences of the traumatic stress, decrease the fear, anxiety and sleeplessness. Data published about benzodiazepines failed to show effectiveness in the acute management of post-traumatic mental consequences. The intention of the third treatment paradigm is characterized by the secondary prevention of PTSD. Benzodiazepines administered shortly after the traumatic event, failed to prevent the mental consequences of traumatic stress. Two small trials with propranolol administration after the trauma have been shown some benefits compared to placebo or no treatment. PTSD represents a complex disregulation of numerous neurotransmitters and neuromodulators, therefore the complex pharmacological treatment has to consider approaches beyond the current treatment regimens characterized by modulation of monoamine neurotransmission.