Davidson J R
Anxiety and Traumatic Stress Program, Duke University Medical Center, Durham, N.C. 27710, USA.
J Clin Psychiatry. 1997;58 Suppl 9:29-32.
Both core and secondary symptoms of posttraumatic stress disorder (PTSD) respond to medication, a valuable part of overall PTSD treatment. Treatment options include antidepressants, anxiolytics, anticonvulsants, and mood stabilizers. A growing data base of results from double-blind, placebo-controlled clinical trials supports the use of antidepressants, especially tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin selective reuptake inhibitors (SSRIs). Although heightened anxiety is characteristic of PTSD, benzodiazepines have not yet proved useful in controlled trials and may be associated with a rebound effect on discontinuation. The small, open studies of anticonvulsant drugs indicate moderate to good improvement with these agents. Tricyclic, SSRI, and MAOI antidepressants have demonstrated efficacy in larger, longer-term controlled trials. Drug/psychotherapy combinations may enhance the usefulness of psychotherapeutics in the management of PTSD. Studies with tricyclics and fluoxetine indicate that magnitude and type of trauma may determine the degree of response.
创伤后应激障碍（PTSD）的核心症状和次要症状都对药物治疗有反应，这是PTSD整体治疗的重要组成部分。治疗选择包括抗抑郁药、抗焦虑药、抗惊厥药和心境稳定剂。双盲、安慰剂对照临床试验的结果数据库不断扩大，支持使用抗抑郁药，尤其是三环类药物、单胺氧化酶抑制剂（MAOIs）和5-羟色胺选择性再摄取抑制剂（SSRIs）。尽管高度焦虑是PTSD的特征，但苯二氮䓬类药物在对照试验中尚未证明有用，且停药后可能会出现反跳效应。对抗惊厥药物的小型开放性研究表明，这些药物能带来中度到良好的改善。三环类、SSRI和MAOI抗抑郁药在规模更大、时间更长的对照试验中已证明有效。药物/心理治疗联合使用可能会提高心理治疗在PTSD管理中的效用。对三环类药物和氟西汀的研究表明，创伤的严重程度和类型可能决定反应程度。
