Follow-up and duration of pharmacotherapy for posttraumatic stress disorder

Throughout antidepressant therapy, regularly review treatment response and monitor for adverse effects. Monitor patients more frequently at the start of treatment because activation and suicidal thoughts are more common during the first 7 to 10 days.

Assess response to antidepressant treatment after 2 to 4 weeks (see Modification and duration of antidepressant therapy for posttraumatic stress disorder). Response to treatment usually becomes apparent after several weeks; full benefit may take 8 weeks or longer.
Figure 1. Modification and duration of antidepressant therapy for posttraumatic stress disorder.

[NB1]

Stopping an antidepressantSwitching antidepressantsFollow-up and duration of pharmacotherapy for posttraumatic stress disorder - Box: Key questions to assess nonresponse to an antidepressant for posttraumatic stress disorderFollow-up and duration of pharmacotherapy for posttraumatic stress disorder - Box: Key questions to assess nonresponse to an antidepressant for posttraumatic stress disorderInitial pharmacotherapy for posttraumatic stress disorder in adults and young peopleInitial pharmacotherapy for posttraumatic stress disorder in adults and young peopleInitial pharmacotherapy for posttraumatic stress disorder in adults and young people
Note:

NB1: If an unacceptable adverse effect occurs at any time, switch to an antidepressant less likely to cause the adverse effect.

NB2: If a low starting dose was used to minimise initial adverse effects (eg nausea, restlessness, agitation), the time to therapeutic effect may be prolonged.

NB3: If symptoms persist despite using an effective dose of at least 2 antidepressants as sequential monotherapy, each for a minimum of 4 to 6 weeks (full benefit may take 8 weeks or longer), see Nonresponse to initial pharmacotherapy for posttraumatic stress disorder in adults and young people.

Figure 2. Key questions to assess nonresponse to an antidepressant for posttraumatic stress disorder

Consider the following questions if a patient does not respond to an antidepressant.

  • Is the diagnosis correct?
  • Have possible medical causes of symptoms been identified and treated?
  • Have alcohol or other substance use problems been addressed?
  • Have relevant psychosocial factors been addressed?
  • Has the patient been treated with an adequate dose of the antidepressant for an adequate duration?
  • Is an interacting drug reducing the response? [NB1]
  • Is the patient adherent to therapy?
    • Have they been taking their antidepressant regularly?
    • Is the patient experiencing an adverse effect?
Note: NB1: Many antidepressants are metabolised by cytochrome P450 enzymes. Information on drug interactions mediated through these enzymes can be found at the University of Indiana School of Medicine’s drug interaction website.