Evidence-based pharmacotherapy of post-traumatic stress disorder

Introduction It is estimated that as many as 80% to 100% of all people are exposed to traumatic events during their lifetimes (Breslau et al., 1998; Frans et al., 2005). Depending on the nature of the trauma, approximately 5–9% of the general population go on to develop post-traumatic stress disorder (PTSD), a condition characterized by the experience of persistent flashbacks of the event (re-experiencing/intrusion symptoms), a state of high arousal when exposed to reminders of the trauma (hyperarousal symptoms), and concomitant avoidance/emotional numbing in response to these reminders (avoidance/emotional numbing symptoms) (Breslau et al., 1998; Frans et al., 2005; Kessler et al., 2005). This constellation of symptoms satisfy the criteria for PTSD when they extend beyond a month after exposure to the trauma and cause clinically significant functional disability, as conceptualized in current psychiatry diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM–IV) (American Psychiatric Association, 1994). PTSD is frequently chronic and associated with significant morbidity, poor quality of life, and high personal, social, and economic costs. It additionally represents a risk factor for developing other mood and anxiety disorders, as well as substance-use disorders. It has been estimated that the US economy alone loses in the region of 3 billion dollars annually due to PTSD-related loss in productivity (Brunello et al., 2001).