Combining Pharmacotherapy with PE for PTSD

Prolonged exposure (PE) is a gold standard treatment for post-traumatic stress disorder (PTSD), and generally, when PE is compared to medications, PE and other imaginal exposure therapies demonstrate stronger effects for PTSD symptoms that are then maintained across time (Lee et al., 2016). Combination treatment of PE with medication, however, is commonly used in practice to manage PTSD, and there is some research examining this combined approach. In practice, patients with PTSD may have been initiated on pharmacotherapy first to address PTSD symptoms as well as common comorbidities such as major depressive disorder, or medication may be initiated concurrently with psychotherapy or after a period of psychotherapy to address residual symptoms or symptom recurrence. The primary focus of this chapter is on medications used in practice that have been shown in clinical trials to have clinically meaningful efficacy in combination with PE for PTSD. This chapter does not discuss brief novel medication augmentation approaches administered during PE sessions to enhance extinction learning and/or retention, as this is covered elsewhere (see Chapter “ Pharmacological, Somatic, and Behavioral Augmentations of PE ”). Clinically relevant factors that can help guide decisions about engaging a patient with PTSD in combination treatment with PE and psychiatric medication are also highlighted.