29 Another possibility for augmentation is for a patient who is very agitated. In such cases, small doses of antipsychotics might be administered. The case for the addition of antipsychotics is even stronger if a concurrence

of psychosis and PTSD is present. Indeed, there are several case reports demonstrating the efficacy of Dinaciclib thioridazine, olanzapine, risperidone, and clozapine.30 Inhibitors,research,lifescience,medical Buspirone, a 5-HT1A agonist, and clonidine have been administered either alone or as augmenting agents in PTSD. As buspirone may be associated with decrease of anxiety, it may be administered either as an augmenting agent for SSRIs or TCAs, or as a stand-alone drug (10-20 mg, three times daily). Clonidine

has been reported in open studies to be effective in ameliorating PTSD symptoms, especially the depression component. Although it has also been used as an augmenting agent for imipramine, Inhibitors,research,lifescience,medical double-blind studies are needed in order to substantiate this claim. There are a number of case reports with antidepressants such as trazodone, venlafaxine, and bupropion, which Inhibitors,research,lifescience,medical in very limited cases under open conditions were reported to be of benefit in improving PTSD symptoms. The doses used were 300 mg for trazodone, 250 mg for venlafaxine, and 300 mg for bupropion. Duration of treatment Very little is known regarding maintenance treatment of the disorder. It seems, though, that there is a spontaneous decrease in the symptoms of PTSD in the first 6 months following the trauma, which continues up to 4 or 5 years. From this standpoint, one should take into account

Inhibitors,research,lifescience,medical this spontaneous recovery when applying psychopharmacological intervention during the first 5 years after the trauma, ie, a gradual down-titration of the dose is called for in order to evaluate Inhibitors,research,lifescience,medical whether the medication is really needed. The same basic rules about discontinuation of medication in other anxiety disorders apply here as well, namely, slow and gradual discontinuation, every 6 weeks or so. The down-titration of medication should be in very small doses. Only if by the end of this period there is no sign of symptom exacerbation may the patient proceed to the next titration. In cases of deterioration, a return to the previous dose seems logical, 17-DMAG (Alvespimycin) HCl although evidence to confirm this is lacking. For patients who have exceeded the 4- to 5-year period, it seems that long-term administration of medication is often needed, although there is still the possibility of spontaneous remission, as long as 10 years following the trauma. A special consideration for long-term maintenance treatment of patients with PTSD is in relation to specific dates in the year that may be associated with an exacerbation of PTSD symptoms, such as the anniversary of the trauma, or memorial days for veterans with PTSD.