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While the CAPS-5 is preferred for initial evaluation, there is literature supportive of a strong correlation between the two measures, and the PCL-5 has the advantage of being quick and easy to administer as a follow up measure for PTSD symptom severity.
It is not known for certain whether these changes were present before the traumatic event and predisposed the person to developing PTSD or if these changes were the result of the PTSD.
The fear circuitry exhibits excessive activation in PTSD and is no longer integrated well with the executive planning and judgment centers in the prefrontal cortex (12).
Trials which are randomized, placebo-controlled, and double blinded are the gold standard for guiding pharmacotherapy decision making.
Less strongly supported evidence includes open trials and case reports.
From the FDA perspective, all other medication uses are off label, though there are differing levels of evidence supporting their use.
From the VA/Do D Clinical Practice Guideline for PTSD perspective, these SSRIs, as well as the SSRIs fluoxetine and paroxetine along with the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine are first-line recommended treatments.
It is vital for the clinician to question the level of evidence supporting the medications being prescribed for PTSD, because there are a variety of influences on prescribing, including marketing, patient preferences, and clinical custom, all of which can be inconsistent with the current evidence base.
The current evidence base for PTSD psychopharmacology is strongest for the selective serotonin reuptake inhibitors (SSRIs), and currently only sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD (1, 2).
A deficiency in amygdala serotonin transport has been identified in some individuals with PTSD (15).Tags: Adult Dating, affair dating, sex dating