Pharmacotherapy

The American College of Forensic Examiners International is approved by the American Psychological Association to sponsor continuing education for psychologists.
Upon return from the war zone, veterans frequently report intrusive thoughts, flashbacks, increased vigilance, avoidance of social situations, hyperarousal, and nightmares.

Treatment involves

• integration of mental health


• primary care


• physical medicine


• attention to substance abuse and


• vocational services.

The mental health portion involves an initial screening of the combat veteran for PTSD and other mental illnesses, followed by a full assessment. Both pharmacotherapy and psychotherapy (individual, couple, and group) are offered for treatment.

Veterans with PTSD find it hard both to fall asleep and to maintain sleep due to hyperarousal and vivid nightmares related to combat. Significant others often report that patients scream in their sleep and may even wake up soaked in sweat.

Prasozin and clonidine both decrease the central nervous system’s noradrenergic activity. They have been found to be effective in decreasing hyperarousal symptoms and improving sleep (Boehnlein, 2007). Other drugs used for sleep are the benzodiazepine class of drugs, like temazepam, and non-benzodiazepines, like zolpidem (Ambien™) and ezopiclone (Lunesta™). However, caution must be taken regarding the habit-forming potential of these drugs.

The presence of psychotic symptoms in PTSD can further complicate the clinical picture. In one study, 20% of the 91 males with combat-stress-related PTSD were found to be suffering from hallucinations and delusions, and hyperarousal was positively associated with the occurrence of psychotic symptoms (Kastelan, 2007). In a small study, augmentation of SSRI with olanzapine (Zyprexa), an atypical antipsychotic, was effective in treating SSRI-resistant combat-related PTSD symptoms, especially sleep (Stein, 2002). In another study, monotherapy with typical or atypical antipsychotics, reduced both PTSD and psychotic symptoms, and antipsychotics seemed to offer another approach to treat the psychotic subtype of combat–related PTSD resistant to previous antidepressant therapy.
Overall, PTSD pharmacotherapy involves several drugs based on our experience with PTSD in general, but well-designed studies are needed to establish treatment guidelines specifically for combat-stress-related PTSD.