Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Table 29 Strength of evidence of pharmacotherapy for core symptoms of PTSD

Agent	Level of evidence	Agent	Level of evidence
Antidepressants
SSRIs		TCAs
Fluoxetine [960–965]	1*	Imipramine [992, 993]	1
Paroxetine [966–970]	1	Amitriptyline [994]	2
Sertraline [971–978]	1*	Desipramine [970, 995]	2*
Fluvoxamine [979–984]	2	MAOIs and RIMAs
Escitalopram [985]	3	Phenelzine [992, 993, 996]	1*
Citalopram [974, 986, 787, 988]	2 (-ve)	Moclobemide [997, 998]	3
SNRIs		Other antidepressants
Venlafaxine XR [975, 989]	1	Mirtazapine [999–1002]	2
Duloxetine [990, 991]	3	Reboxetine [984]	2
		Bupropion SR 1003	3
		Tianeptine [997, 1004]	3
		Adjunctive bupropion SR 1005	2 (-ve)
*Other therapies*
Anxiolytics		Anticonvulsants
Benzodiazepines		Topiramate [1009, 1010]	1*
Alprazolam 1006	2 (-ve)	Lamotrigine 1011	2
Clonazepam [881, 1007, 1008]	3 (-ve)	Carbamazepine [1012, 1013]	3
Atypical antipsychotics		Divalproex [1014–1017]	1 (-ve)
Risperidone 1030	2	Tiagabine 1018	2 (-ve)
Aripiprazole [1031–1033]	3	Adjunctive gabapentin [1019, 1020]	4
Quetiapine [1034, 1035]	3	Adjunctive levetiracetam 1021	4
Olanzapine [1036–1038]	2 (-ve)	Adjunctive pregabalin 1022	4
Adjunctive risperidone [1039–1044]	1*	Adjunctive tiagabine [1023–1025]	4
Adjunctive olanzapine 1045	2	Adjunctive topiramate [1026–1029]	2 (-ve)
Adjunctive aripiprazole [1033, 1046, 1047]	3	Other treatments
Adjunctive quetiapine [1048–1050]	3	Buspirone [1051, 1052]	4
		Trazodone 1053	4
		Memantine 1054	4
		Adjunctive eszopiclone 1055	2
		Adjunctive clonidine 1056	3
		Adjunctive guanfacine [1057, 1058]	1 (-ve)
		Adjunctive zolpidem 1059	2 (-ve)

*Conflicting data. MAOI = monoamine oxidase inhibitor; RIMA = reversible inhibitor of monoamine oxidase A; SNRI = serotonin–norepinephrine reuptake inhibitor; SR = sustained release; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; XR=extended release; (-ve) = negative.

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