Assignment:
- Reply to at least one classmate (from a different discussion group)
- Posts are a minimum of 250 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and a minimum of 2 references (which may include the course textbook).
Question: Most PTSD treatment guidelines recommend against the use of benzodiazepines. Need Assignment Help?
- Provide an evidence-based discussion regarding the use of benzodiazepines in the treatment of PTSD.
- Consider discussing information like the safety and efficacy reported in the literature, the effect benzodiazepines have on other common treatment modalities for PTSD, etc.
- Include first-line agents for PTSD in the discussion.
Student's Response:
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in individuals who have been exposed to a traumatic event, and is characterized by many undesirable symptoms, such as intrusive thoughts, avoidance of triggers, behavioral changes, as well as dissociation (Gabbard & M.d., 2014). Treating this condition mainly focuses on psychotherapy; however, when such modalities are not available or declined, first-line psychopharmacotherapy includes selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Gabbard & M.d., 2014). SSRI agents such as sertraline and paroxetine are preferred, and venlafaxine is the preferred agent for the SNRI drug class (Gabbard & M.d., 2014). Benzodiazepines (BZDs) are anxiolytics that overall treat anxiety; however, in the treatment of PTSD, there is little evidence to support that this drug class is beneficial (Silva de Lima & da Silva, 2025). Current evidence strongly recommends against the use of BZDs in the treatment of PTSD (Silva de Lima & da Silva, 2025). Multiple major clinical practice guidelines and systematic reviews agree on this position, citing a lack of efficacy and significant potential for harm (Gabbard & M.d., 2014). The 2023 VA/DoD Clinical Practice Guideline explicitly states the use of BZDs for the treatment of PTSD is not recommended (Schnurr et al., 2024). The 2025 American Psychological Association (APA) Guideline holds the same view that BZDs do not show any benefit and are not efficacious in the treatment of PTSD (Silva de Lima & da Silva, 2025). The APA also warns against the use of BZDs due to the increased risk of sedation, cognitive impairment, and the potential for abuse (Silva de Lima & da Silva, 2025). The Cochran review, through a systematic review, discusses the lack of efficacy in the treatment of PTSD with BZDs, citing poor-quality evidence extracted from several trials (Williams et al., 2026). BZDs use in PTSD is associated with many safety concerns, including the risk of increased PTSD severity, substance abuse risk, increased risk of depression/aggression, cognitive impairment, dependence/withdrawal, and overdose risk (Brunner et al., 2025). BZDs may undermine the treatments that actually work for PTSD, for example, in trauma-focused therapy, there is a concern that BZD use may interfere with fear extinction, which is the core mechanism underlying exposure-based interventions (Schnurr et al., 2024). In conclusion, first-line psychopharmacotherapy treatment for PTSD includes sertraline, paroxetine, and venlafaxine, which are all supported by multiple guidelines (Gabbard & M.d., 2014). It is important to note that the preferred initial treatment of PTSD still remains trauma-focused psychotherapy.
References:
Brunner, E., Chen, C.-Y. A., Klein, T., Maust, D., Mazer-Amirshahi, M., Mecca, M., Najera, D., Ogbonna, C., Rajneesh, K. F., Roll, E., Sanders, A. E., Snodgrass, B., VandenBerg, A., & Wright, T. (2025). The joint clinical practice guideline on benzodiazepine tapering: considerations when benzodiazepine risks outweigh benefits. American Society of Addiction Medicine.
Gabbard, G. O., & M.d. (2014). Gabbard's treatments of psychiatric disorders, fifth edition (5th ed.). American Psychiatric Pub.
Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C., Fuller, M. A., Holtzheimer, P. E., Kelly, U., Lang, A. J., McGraw, K., Morganstein, J. C., Norman, S. B., Papke, K., Petrakis, I., Riggs, D., Sall, J. A., Shiner, B., Wiechers, I., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. department of veterans affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine, 177(3), 363-374.
Silva de Lima, M., & da Silva, A. G. (2025). Benzodiazepines for PTSD: Poor Data quality and misleading advice. Journal of Psychopharmacology, 39(8), 883-885.
Williams, T., Phillips, N. J., Stein, D. J., & Ipser, J. C. (2026). Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 2026(5).