New Condition: Anxiety: Post-Traumatic Stress Disorder (PTSD)

08 Dec New Condition: Anxiety: Post-Traumatic Stress Disorder (PTSD)

We are pleased to announce the addition of a new condition: Anxiety – Post-Traumatic Stress Disorder to our TreatGx medication decision support software. The PTSD treatment algorithm can be accessed by all TreatGx users. PTSD is a type of anxiety disorder which may develop after an individual is involved in or witnesses a traumatic event. With regards to current events, the COVID-19 pandemic may lead to PTSD, such as in patients surviving COVID-19 hospitalization, people experiencing the death of a loved one, or healthcare workers facing the trauma of overwhelming numbers of patients, many of whom are extremely sick, and the constant anxiety about catching or transmitting COVID-19.

The TreatGx PTSD algorithm provides guidance on psychotherapy (the preferred initial treatment option for most patients), including trauma-focused cognitive behavioral therapy (TFCBT) or eye movement desensitization and reprocessing (EMDR), in addition to pharmacotherapy options if psychotherapy is not initially feasible for treating core symptoms of PTSD.

Medication treatment options included in TreatGx for treatment of PTSD include: fluoxetine, paroxetine, sertraline, venlafaxine, amitriptyline, imipramine, mirtazapine, nefazodone (available in the U.S. only), phenelzine, and risperidone augmentation. TreatGx provides personalized dosing and options based on kidney function, liver function, medical history, age, pharmacogenetics, and drug-gene/drug-drug/drug-condition interactions. In addition, key differences in side effects and safety considerations are highlighted to help guide treatment choice based on patient priorities.

The latest clinical guidelines and meta-analyses for PTSD were reviewed to provide medication options and additional notes on efficacy and supporting evidence. These included: BMJ Best Practice 2019 Guideline [1], the Department of Veterans Affairs/Department of Defense 2017 Guideline [2], the National Institute for Health and Care Excellence 2018 Guideline [3], the American Psychological Association 2017 Guideline [4], the 2014 Canadian Guideline [5], and Hoskins et al. 2015 systematic review and meta-analysis [6].

References: 

1. Zammit S, Hoskins M, Lewis C: Post-traumatic stress disorder. In: BMJ Best Practice. 2019. 
2. Department of Veterans Affairs/Department of Defense: VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. 2017. 
3. National Institute for Health and Care Excellence: Post-traumatic stress disorder [NICE Guideline NG116]. 2018. 
4. American Psychological Association: Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2017. 
5. Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, Antony MM, Bouchard S, Brunet A, Flament M et al: Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014, 14 Suppl 1(Suppl 1):S1. 
6. Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, van Ommeren M, de Jong J, Seedat S, Chen H et al: Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry 2015, 206(2):93-100.