Treatment-Resistant Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a prevalent, disabling condition with considerable comorbidity and morbidity. There is growing evidence supporting the efficacy and safety of pharmacotherapeutic and psychotherapeutic interventions for PTSD. However, a significant proportion of individuals with PTSD do not respond to first-line treatments. Strategies for managing treatment-resistant PTSD include switching to a different treatment, increasing dose and duration of pharmacotherapy, augmenting pharmacotherapy with a drug from a different class, or combining pharmacotherapy with psychotherapy. This chapter reviews the current evidence for these various strategies as well as novel approaches targeting the disrupted neuronal circuitry and molecular mechanisms hypothesized to underlie PTSD.