Table IV. Posttraumatic stress disorder (PTSD): therapeutic strategies. SSRI, selective serotonin reuptake inhibitor; TCA, tricylic antidepressant.

Predominant clinical features	First-line treatment	Partial or no response
• Intusive thoughts and flashbacks, hyperarousal, impulsivity	SSRI (fluoxetine, paroxetine, sertraline) or mood stabilizer (carbamazepine, lithium, valproate)
		SSRI and/or mood stabilizer (also topiraramate and gabapentin) combination
• Anxiety without severe depression, irritability, insomnia	Alprazolam, clonazepam, or buspirone
• Depressive symptoms	SSRI (fluoxctine, paroxetine, sertraline), or TCA (imipramine, amitriptyline), or phenelzine	Add nefazodone or trazodone for concurrent sleep disorders
• Psychotic symptoms, agressivity, or agitation	Olanzapine