Trauma is a transversal psychopathological dimension, involved in the etiology of various psychiatric disorders and very often nuclear distress of the same.The current nosographic classification, which is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5: American Psychiatric Association, 2013), to which the latest version of the International Classification of Diseases (ICD-11) converges, however, concentrates the treatment of trauma within a diagnostic category, post traumatic stress disorder (PTSD).
The drug treatments experimented at the forefront of PTSD are antidepressant drugs, given the wide comorbidity with major depressive disorder and with anxiety disorders (in particular generalized anxiety disorder and panic disorder), all highly responsive to this antidepressant therapy, as it was conceivable, has shown some efficacy in reducing the depressive and anxious symptoms that are part of the symptomatological procession of PTSD, however revealing itself inactive on the specific symptoms of PTSD, such as emotional activation, secondary to ‘sudden intrusion of the traumatic event in the patient’s ideation and perception, hypervigilance, flashbacks, nightmares, avoidance, discomfort in the professional and relational sphere and the failed strategies that the patient adopts in an attempt to soothe the suffering, including alcohol or drugs.
The anticonvulsant stabilizing drugs, such as lamotrigine, carbamazepine, pregabalin, gabapentin, tiagabine, topiramate and valproate, in the few scientific studies dedicated to their use in the treatment of PTSD, have been found to be ineffective or to be avoided. On the other hand, clinical experience has shown how the use of some of these molecules (valproate, lamotrigine, carbamazepine) can lead to a containment of impulsiveness and hyper-vigilance, acting on emotional dysregulation, while the use of others, the alpha-2 ligands pregabalin and gabapentin, through direct action on neuropathic pain, often present in patients with PTSD, would help reduce the impact of the stressful stimulus on memory and mood and smooth the conditioning mechanism of fear, through direct “relief” for body memory.
Regarding antipsychotics, II generation molecules have been tested, in particular olanzapine and risperidone with some results on comorbid psychotic disorders, with adjuvant function in the antidepressant sense, or for the treatment of ruminative thinking, often present in subjects affected by trauma. Due to its possible usefulness in this sense, risperidone in addition to SSRI therapy was recently recommended by the European guidelines (NICE 2018).
Other “non-psychiatric” pharmacological categories used in the treatment of PTSD are antiadrenergic drugs (alpha and beta), which should act on the reduction of hypervigilance, flashbacks and dissociative symptoms. Among these, the antihypertensive alpha1 blocker prazosin has been widely used in the past in the treatment of nightmares (Charney et al., 2018), but is currently being reconsidered as ineffective (Raskind et al, 2018).
In conclusion, the most complete and recent reviews of the literature (Davis et al., 2015; Charney et al., 2018) agree in highlighting how psychopharmacological interventions on the “trauma dimension” show rather limited therapeutic effects, with a small effect size and how are of limited use when not associated with psychotherapeutic pathways. In this sense it is necessary to take into account how all international guidelines identify psychotherapy as the treatment of choice for PTSD.