Pharmacological and Psychoactive Agents for Treatment Resistant Posttraumatic Stress Disorder

The Food and Drug Administration (FDA) approved two selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine for the treatment of posttraumatic stress disorder. Many patients do not respond to them and their side effects commonly occur before noticeable therapeutic effects, leading to their discontinuation. Other patients develop treatment resistance to the two approved SSRIs and are treated with other pharmacological agents. A sizable number of patients also do not respond to pharmacological agents and resort to the use of experimental psychoactive agents. This article reviews the definition of treatment resistant posttraumatic stress disorder, and summarizes the various pharmacological and psychoactive agents that have been used for treatment resistant posttraumatic stress disorder including various antidepressants, antipsychotics ,noradrenergic agents, anticonvulsants, mood stabilizers, anxiolytics, hypnotics ,antihistaminergic agents, naltrexone, buprenorphine, D-Cycloserine, neuropeptides, memantine, cannabinoids, 3,4-methylendioxymethamphetamine and ketamine.