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Answer 2
  1. Sertraline. Sertraline is a selective serotonin reuptake inhibitor (SSRI). SSRIs are considered first-line treatment for PTSD because of their effectiveness against all 3 symptoms of PTSD (ie, sense of reliving a traumatic experience, avoidance, and increased arousal).2 SSRIs are also appropriate treatment for patients with acute stress disorder.2 Alprazolam is a benzodiazepine used for treating symptoms of anxiety but has not been proven effective in treating PTSD.3 Amitriptyline, a tricyclic antidepressant medication, can be used to treat PTSD but is not considered first-line treatment.4 Risperidone is an antipsychotic medication that can be used to augment SSRIs if first-line treatment options are ineffective.5,6 Divalproex is an anticonvulsant medication with mood-stabilizing effects used for treating mania associated with bipolar disorder, epilepsy, and as prophylaxis for migraine. It has been shown to reduce intrusion and hyperarousal symptoms but has no significant effect on avoidance/numbing symptoms.7

     Londborg PD, Hegel MT, Goldstein S, et al. Sertraline treatment of posttraumatic stress disorder: results of 24 weeks of open-label continuation treatment. J Clin Psychiatry 2001;62:325–31.

    3. Braun P, Greenberg D, Dasberg H, Lerer B. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry 1990;51:236–8.

    4. Davidson J, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry 1990;47:259–66.

    5. Bartzokis G, Lu PH, Turner J, et al. Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder. Biol Psychiatry 2005;57: 474–9.

    6. Rothbaum BO, Killeen TK, Davidson JR, et al. Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor-resistant civilian posttraumatic stress disorder. J Clin Psychiatry 2008;69:520–5.

    7. Clark RD, Cañive JM, Calais LA, et al. Divalproex in posttraumatic stress disorder: an open-label clinical trial. J Trauma Stress 1999;12:395–401.

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