Sutherland S M, Davidson J R
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
Psychiatr Clin North Am. 1994 Jun;17(2):409-23.
PTSD is a common disorder with high comorbidity and a tendency toward chronicity, which responds slowly to treatment and, in many patients, may not totally resolve even with long-term treatment. For most persons with PTSD, a combined approach to treatment is beneficial, at least in the acute stages of the illness. Pharmacotherapy is an important component of treatment during the acute stages of the illness and may be necessary on a long-term basis for many patients. Because the data from controlled trials of pharmacotherapy are limited, it is not possible to present a unified approach or develop a consensus that is well supported by research findings. What has emerged from the available data is that antidepressants, particularly those with serotoninergic properties, are helpful for core PTSD symptoms when given at higher dose levels for at least 5 to 8 weeks. The TCAs as a group appear to be effective in amelioration of the intrusive symptoms and of anxiety and depressive symptoms, while having little effect on avoidance symptoms. Initial data from studies of the SSRIs suggests that they may have greater efficacy than other drugs in the treatment of avoidance and numbing symptoms and may effect enough overall global improvement in PTSD symptoms that some patients will no longer meet the diagnostic criteria. The hyperarousal symptoms may respond somewhat to antidepressants, but should symptoms continue to be disabling, buspirone or benzodiazepines may be indicated. In choosing a benzodiazepine, those less likely to have distressing withdrawal symptoms, such as clonazepam and chlordiazepoxide, should be considered. Clonazepam, with its serotoninergic properties, may prove to be a particularly efficacious drug. For some patients, phenelzine may be a good choice because it has proven efficacy for the intrusive PTSD symptoms, for depressive symptoms, and for some symptoms of autonomic arousal, such as panic attacks. Other agents to be considered for alleviation of hyperarousal symptoms are lithium, anticonvulsants, and clonidine. In addressing the symptoms of poor impulse control, lithium, beta-blocking drugs, and carbamazepine may be helpful. Brief psychotic episodes should respond to a neuroleptic, although psychoticlike dissociative spells may be nonresponsive.
创伤后应激障碍（PTSD）是一种常见疾病，共病率高且有慢性化倾向，对治疗反应缓慢，许多患者即便接受长期治疗也可能无法完全康复。对于大多数PTSD患者，综合治疗方法有益，至少在疾病急性期如此。药物治疗是疾病急性期治疗的重要组成部分，对许多患者可能长期都有必要。由于药物治疗对照试验的数据有限，无法给出统一的治疗方法或形成有充分研究结果支持的共识。现有数据显示，抗抑郁药，尤其是具有5-羟色胺能特性的药物，在高剂量水平服用至少5至8周时，对PTSD的核心症状有帮助。三环类抗抑郁药总体上似乎对缓解侵入性症状、焦虑和抑郁症状有效，但对回避症状影响不大。选择性5-羟色胺再摄取抑制剂（SSRI）的初步研究数据表明，它们在治疗回避和麻木症状方面可能比其他药物更有效，并且可能使PTSD症状有足够的整体改善，以至于一些患者不再符合诊断标准。抗抑郁药对过度警觉症状可能有一定疗效，但如果症状持续导致功能障碍，可能需要使用丁螺环酮或苯二氮䓬类药物。在选择苯二氮䓬类药物时，应考虑那些不太可能有令人痛苦的戒断症状的药物，如氯硝西泮和氯氮䓬。氯硝西泮具有5-羟色胺能特性，可能证明是一种特别有效的药物。对于一些患者，苯乙肼可能是个不错的选择，因为它已被证明对PTSD的侵入性症状、抑郁症状以及一些自主神经觉醒症状（如惊恐发作）有效。其他可考虑用于缓解过度警觉症状的药物有锂盐、抗惊厥药和可乐定。在处理冲动控制不良症状方面，锂盐、β受体阻滞剂和卡马西平可能有帮助。短暂的精神病性发作对抗精神病药物应该有反应，不过类似精神病性的分离性发作可能无反应。
