Clinical interventions
None of these can be done at home. Know what they are, what the evidence says, and how to find a provider worth trusting.
★ PTSDIY · Field Manual ★ Part V ★
Chapter 23
Medications
Know what to ask for
FM 23-MED-201Weeks to effect
23-1.Mission brief
Medication doesn't erase trauma, but it can turn down the volume enough to sleep, function and do the deeper work. Some medications have strong evidence for PTSD; some commonly prescribed ones don't.
23-2.Intel
The VA/DoD guideline recommends four medications for PTSD. Therapy is recommended over medication when both are available; many people use both.
23-3.The short list
| Medication | Class | Notes |
|---|---|---|
| Sertraline (Zoloft) | SSRI | FDA-approved for PTSD. |
| Paroxetine (Paxil) | SSRI | FDA-approved for PTSD. |
| Fluoxetine (Prozac) | SSRI | Recommended in guidelines. |
| Venlafaxine (Effexor) | SNRI | Recommended in guidelines. |
| Prazosin | Alpha-blocker | Used for trauma nightmares; evidence is mixed. Ask if nightmares are your main problem. |
23-4.Use caution
| Medication | Why |
|---|---|
| Benzodiazepines (Xanax, Valium, Klonopin) | Guidelines recommend against them for PTSD. They can interfere with therapy and carry dependence risk. |
| Cannabis products | Not recommended as PTSD treatment (Chapter 14). |
23-5.Field procedures — your prescriber visit
| 01 | Bring your mapPCL-5 score and symptom log from Chapter 4. | — |
| 02 | Ask the four questionsIs this recommended for PTSD? How long until it works? What side effects should I expect? How do we stop it if needed? | — |
| 03 | Give it timeSSRIs and SNRIs usually take several weeks for full effect. Track symptoms weekly. | 6–12 wks |
| 04 | Report side effectsSleep, sexual function, stomach, mood. Most can be managed by adjusting dose or switching. | — |
23-6.Rules of engagement
Warning — Never stop an antidepressant suddenly without talking to your prescriber; withdrawal effects can be rough. If you notice new or worsening thoughts of suicide after starting or changing a medication, contact your prescriber or call 988 right away.
23-7.Common faults & corrections
| ✕ | Fault: Quitting at week twoCorrection: Most people stop before the medication had a chance to work. |
| ✕ | Fault: Medication instead of therapyCorrection: Use it to make therapy possible, not to replace it. |
PTSDIY · FM 23-MED-201 · Part V23