Pharmacotherapy for recently evacuated military casualties

Psychiatric military casualties evaluated 1-3 weeks after evacuation from the front, pose a unique diagnostic problem because it is too early to tell whether they are exhibiting the first episodes of a chronic psychiatric disorder. In order to gain a better diagnostic perspective, we recommend withholding any pharmacotherapy for at least 48 hours, if possible. We also recommend treating such patients etiologically rather than symptomatically whenever possible. Although there are no data on drug treatment for acute post-traumatic stress (PTS) reactions, we recommend sympatholytic and panicolytic agents such as clonidine, propranolol, tricyclic antidepressants, and monoamine oxidase inhibitors for PTS patients who exhibit high levels of anxiety and agitation. We speculate that serotonin reuptake inhibitors such as fluoxetine and clomipramine might be more effective for PTS patients in whom dysphoria and avoidant/numbing symptoms are prominent.