托吡酯
两个小的随机对照试验在评估托吡酯治疗创伤后应激障碍疗效时结果并不一致。两项 meta 分析建议将其用作单药治疗。[77]Jonas DE, Cusack K, Forneris CA, et al. Psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). Comparative effectiveness review No. 92. AHRQ publication no. 13-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2013.http://www.ncbi.nlm.nih.gov/books/NBK137702/http://www.ncbi.nlm.nih.gov/pubmed/23658937?tool=bestpractice.com[85]Watts BV, Schnurr PP, Mayo L, et al. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry. 2013;74:e541-e550.http://www.ncbi.nlm.nih.gov/pubmed/23842024?tool=bestpractice.com不过，这些 meta 分析包含一项小规模的强化研究，其中混合的精神病治疗药物被允许用于实验组和安慰剂组。当强化研究得出的数据被排除在另一项 meta 分析之外时，[84]Hoskins M, Pearce J, Bethell A, et al. Pharmacotherapy for post-traumatic stress disorder: a systematic review and meta-analysis. Br J Psychiatry. 2015;206:93-100.http://bjp.rcpsych.org/content/206/2/93.longhttp://www.ncbi.nlm.nih.gov/pubmed/25644881?tool=bestpractice.com没有证据证明托吡酯的疗效优于安慰剂，因而不推荐将其用于 PTSD 的循证单药治疗。目前还没有足够的证据推荐它作为一种治疗方法。[84]Hoskins M, Pearce J, Bethell A, et al. Pharmacotherapy for post-traumatic stress disorder: a systematic review and meta-analysis. Br J Psychiatry. 2015;206:93-100.http://bjp.rcpsych.org/content/206/2/93.longhttp://www.ncbi.nlm.nih.gov/pubmed/25644881?tool=bestpractice.com[93]Yeh MS, Mari JJ, Costa MC, et al. A double-blind randomized controlled trial to study the efficacy of topiramate in a civilian sample of PTSD. CNS Neurosci Ther. 2011;17:305-310.http://www.ncbi.nlm.nih.gov/pubmed/21554564?tool=bestpractice.com[94]Tucker P, Trautman RP, Wyatt DB, et al. Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2007;68:201-206.http://www.ncbi.nlm.nih.gov/pubmed/17335317?tool=bestpractice.com
替代治疗
两项关于针灸治疗和冥想疗法治疗创伤后应激障碍的小样本随机对照试验已经显示出可喜疗效，但目前证据尚不足以推荐这些干预措施。[95]Strauss JL, Lang AJ, Schnurr PP; National Center for PTSD. Complementary and alternative medicine (CAM) for PTSD. May 2016. http://www.ptsd.va.gov/ (last accessed 7 October 2016).http://www.ptsd.va.gov/professional/treatment/overview/complementary_alternative_for_ptsd.asp
虚拟现实疗法
一项关于探索创伤性战争与灾后情况的视听模拟是否有助于以暴露为基础的心理干预的小样本试验已经显示出初步疗效。[96]Difede J, Cukor J, Jayasinghe N, et al. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry. 2007;68:1639-1647.http://www.ncbi.nlm.nih.gov/pubmed/18052556?tool=bestpractice.com
N-甲基-D-天冬氨酸 (NMDA) 受体激动剂
已有报道 NMDA 激动剂（例如 D-环丝氨酸）与强迫性障碍、社交恐惧症和惊恐障碍的相关应用来提高以暴露为基础的心理干预效果。指南也报道此类药物有提高创伤后应激障碍心理治疗效果的潜力。[57]Benedek DM, Friedman MJ, Zatzick D, et al. Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. 2009. http://psychiatryonline.org/ (last accessed 7 October 2016).http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-watch.pdf然而，这些指南强调在该指南发布时，使用 D-环丝氨酸或任何其他药物以提高创伤后应激障碍患者对心理干预反应性的研究并未见报道。一项近期的系统评价[80]Hetrick SE, Purcell R, Garner B, et al. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2010;(7):CD007316.http://www.ncbi.nlm.nih.gov/pubmed/20614457?tool=bestpractice.com与随后一项 meta 分析得出了同样的结论，这项分析包含针对 PTSD 成人患者实施 D-环丝氨酸强化治疗的 5 项研究。[97]Ori R, Amos T, Bergman H, et al. Augmentation of cognitive and behavioural therapies (CBT) with D-cycloserine for anxiety and related disorders. Cochrane Database Syst Rev. 2015;(5):CD007803.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007803.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25957940?tool=bestpractice.com
哌唑嗪
关于α肾上腺素受体拮抗剂哌唑嗪的一系列对照试验（纳入少数的受试者）已在治疗 PTSD 相关的恶梦和睡眠障碍中显示出良好的应用前景。[98]Raskind MA, Peskind ER, Kanter ED, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160:371-373.http://www.ncbi.nlm.nih.gov/pubmed/12562588?tool=bestpractice.com[99]Raskind MA, Peskind ER, Hoff DJ, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61:928-934.http://www.ncbi.nlm.nih.gov/pubmed/17069768?tool=bestpractice.com[100]Taylor FB, Martin P, Thompson C, et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry. 2008;63:629-632.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350188/http://www.ncbi.nlm.nih.gov/pubmed/17868655?tool=bestpractice.com
MDMA 辅助心理治疗
两项小规模的随机对照试验已对 3,4-亚甲二氧基甲基苯丙胺 (MDMA)-辅助心理治疗用于治疗慢性难治性创伤后应激障碍进行了研究。[101]Mithoefer MC, Wagner MT, Mithoefer AT, et al. The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol. 2011;25:439-452.http://jop.sagepub.com/content/25/4/439.longhttp://www.ncbi.nlm.nih.gov/pubmed/20643699?tool=bestpractice.com[102]Oehen P, Traber R, Widmer V, et al. A randomized, controlled pilot study of MDMA (± 3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). J Psychopharmacol. 2013;27:40-52.http://jop.sagepub.com/content/27/1/40.longhttp://www.ncbi.nlm.nih.gov/pubmed/23118021?tool=bestpractice.com第一项研究报道在 MDMA 组的临床反应率为 83%，而安慰剂组为 25%。[101]Mithoefer MC, Wagner MT, Mithoefer AT, et al. The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol. 2011;25:439-452.http://jop.sagepub.com/content/25/4/439.longhttp://www.ncbi.nlm.nih.gov/pubmed/20643699?tool=bestpractice.com长期随访已发现有统计学意义和临床意义的症状学缓解，且在该研究中未见受试者受到 (MDMA) 伤害的报告。[103]Mithoefer MC, Wagner MT, Mithoefer AT, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol. 2013;27:28-39.http://jop.sagepub.com/content/27/1/28.longhttp://www.ncbi.nlm.nih.gov/pubmed/23172889?tool=bestpractice.com第二项研究并未发现 MDMA 组的临床用创伤后应激障碍诊断量表 (CAPS) 得分的减少有统计学显著性，但创伤后应激障碍症状的自我报告的确有临床和统计学意义的显著改善。[102]Oehen P, Traber R, Widmer V, et al. A randomized, controlled pilot study of MDMA (± 3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). J Psychopharmacol. 2013;27:40-52.http://jop.sagepub.com/content/27/1/40.longhttp://www.ncbi.nlm.nih.gov/pubmed/23118021?tool=bestpractice.com
右佐匹克隆
一项小规模的随机对照试验 (RCT) 研究了右佐匹克隆的使用，发现其对睡眠和 PTSD 症状有一定的改善作用。不过，患者同时接受了单药治疗和强化治疗，所以有必要采用更为严格的方法开展进一步的研究。[104]Pollack MH, Hoge EA, Worthington JJ, et al. Eszpolicone for the treatment of posttraumatic stress disorder and associated insomnia: a ramdomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2011;72:892-897.http://www.ncbi.nlm.nih.gov/pubmed/21367352?tool=bestpractice.com
氢化可的松
有适度的证据支持医学上将氢化可的松用于预防 PTSD 发作的临床情况，但没有证据支持使用普萘洛尔、艾司西酞普兰、替马西泮或加巴喷丁。在大部分研究中，干预都是在创伤性事件发生后的 12 小时内施行。[105]Amos T, Stein DJ, Ipser JC. Pharmacological interventions for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2014;(7):CD006239.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006239.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25001071?tool=bestpractice.com [ 
]What are the benefits and harms of pharmacological interventions for preventing post-traumatic stress disorder (PTSD)?http://cochraneclinicalanswers.com/doi/10.1002/cca.516/full显示答案
