Pharmacological prevention of PTSD: Current evidence for clinical practice

Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that develops in approximately 10% of people exposed to trauma. As traumatic events are the point of reference for PTSD symptom onset, the first hours to weeks posttrauma provide opportunities for preventive interventions. In this article, we discuss current evidence on pharmacological preventive interventions for PTSD in adults. We conclude that there are no pharmacological preventive interventions that are ready for routine clinical practice. However, there is emerging evidence for the efficacy of hydrocortisone administration initiated within 12 hours posttrauma. Propranolol, escitalopram, and benzodiazepines are not likely to reduce PTSD development. We also recommend caution in prescribing benzodiazepines early posttrauma due to potential risk of increasing PTSD symptoms. Further research on the preventive effects of opiates and oxytocin is warranted, as previous studies have shown promising results. To further advance the field and to ultimately realize effective and clinically feasible pharmacological preventive interventions for PTSD, reliable risk identification of PTSD, acceptability of preventive interventions, and implementation strategies should be investigated. [Psychiatr Ann. 2019;49(7):307–313.]