Last updated: 09-10-2026

Medication, Therapy or Both for PTSD?

In short: The 2023 VA/DoD guideline recommends three trauma-focused psychotherapies over medication when both are available. It also recommends three antidepressants, two of them FDA-approved for PTSD, and recommends against benzodiazepines and cannabis. It finds insufficient evidence for or against combining therapy and medication. Medication decisions belong with a prescriber.

This article reports what official sources say about medication and therapy for PTSD. It is not advice to start, stop or change any medication. Those decisions are made with the clinician who prescribes it. No doses are given.

Most of the detail comes from two U.S. guidelines: the 2023 guideline of the Departments of Veterans Affairs and Defense (VA/DoD), which says it is not intended to define a standard of care, and the American Psychological Association's 2025 guideline.

What do guidelines recommend first?

Therapy, where it is available. The VA/DoD guideline states, with its "Strong for" rating: "We recommend individual psychotherapies, listed in Recommendation 8, over pharmacologic interventions for the treatment of PTSD." Recommendation 8 names cognitive processing therapy, EMDR and prolonged exposure, which are compared in types of trauma therapy and what the research says.

The guideline does not say medication fails. Its discussion reads: "Both psychotherapy (see Recommendation 8) and pharmacotherapy (see Recommendation 15) are effective in treating PTSD. When both treatment modalities are available and feasible, the Work Group recommends the use of the indicated psychotherapies over the indicated pharmacotherapies." It cites meta-analyses indicating that trauma-focused psychotherapies bring greater change in core PTSD symptoms than medications do, and that the improvements persist for longer. It also reports a counter-example, a randomized trial comparing prolonged exposure, sertraline and the combination that "found no difference among the groups over the 24 weeks that medication was provided."

Which medicines do guidelines recommend?

Three antidepressants in one guideline and four in the other. VA/DoD, rated "Strong for": "We recommend paroxetine, sertraline, or venlafaxine for the treatment of PTSD." The American Psychological Association's rating is "Conditional For." It suggests offering fluoxetine, paroxetine, sertraline and venlafaxine. The two differ on fluoxetine, which VA/DoD places under insufficient evidence to recommend for or against.

FDA approval is narrower. A VA page for clinicians says: "Currently, only sertraline and paroxetine are approved by the Food and Drug Administration (FDA) for PTSD. From the FDA perspective, all other medication uses are off label." The current labels for sertraline (Zoloft) and paroxetine (Paxil) both list PTSD among their approved uses. Venlafaxine is therefore recommended by guidelines but off label for PTSD.

A 2022 Cochrane review covered 66 randomized trials with 7,442 participants. SSRIs, the class of antidepressant that sertraline belongs to, improved PTSD symptoms in 58% of participants compared with 35% of those on placebo, on moderate-certainty evidence. About 9% of people in the SSRI groups dropped out because of adverse events. The trials ran from 13 days to 28 weeks. The reviewers concluded that SSRIs improve PTSD symptoms, and that there remain important gaps in the evidence and "a continued need for more effective agents."

Which medicines do guidelines advise against?

VA/DoD names several, at two strengths.

Benzodiazepines. "Strong against": "We recommend against benzodiazepines for the treatment of PTSD." The discussion says they "are associated with misuse, decreased effectiveness of recommended PTSD treatments, and cognitive changes, especially in the elderly." The American Psychological Association gives a "Conditional Against" rating to one benzodiazepine, alprazolam.
Cannabis. "Strong against": "We recommend against cannabis or cannabis derivatives for the treatment of PTSD." The reasons given are the lack of well-designed randomized trials in large samples of people with PTSD and "the serious side effects associated with their use."
Seven other medicines. "Weak against": "We suggest against divalproex, guanfacine, ketamine, prazosin, risperidone, tiagabine, or vortioxetine for the treatment of PTSD." VA/DoD also suggests against adding any of a list of antipsychotics to other medications for PTSD.

Two points of difference. Prazosin: the American Psychological Association rates it insufficient evidence, not advised against, and VA/DoD itself gives a "Weak for" rating to prazosin for nightmares associated with PTSD, which flashbacks, nightmares and triggers covers. Topiramate: the American Psychological Association suggests against it ("Conditional Against"), while VA/DoD places it under insufficient evidence to recommend for or against.

If you already take one of these medicines, this list is not an instruction to stop. Any change is something to plan with the prescriber.

What about MDMA, ketamine and cannabis?

None is an approved or recommended PTSD treatment in the sources used for this guide.

MDMA-assisted therapy. VA/DoD found "insufficient evidence to recommend for or against" it. On August 8, 2024, the FDA wrote to the company that had applied for approval that "we cannot approve this application in its present form," concluding that the application "does not provide substantial evidence of effectiveness or establish the safety of your product." The American Psychological Association says MDMA "was not approved by the FDA for PTSD and is only available for research purposes or available illegally." This information is current to October 9, 2026, when the FDA's published record of that letter still listed the application as unapproved.

Ketamine and cannabis. Ketamine is on the VA/DoD "suggest against" list above, and cannabis carries its strong recommendation against. The American Psychological Association says neither cannabis nor psilocybin had enough high-quality randomized trials to be evaluated, and that they cannot be recommended, at present, as a treatment for PTSD. For psilocybin and several other psychedelics, VA/DoD finds insufficient evidence for or against.

Is combining medication and therapy better?

The evidence is too thin to say. VA/DoD finds insufficient evidence to recommend for or against combining psychotherapy and medication for PTSD.

A 2019 network meta-analysis looked at 12 randomized trials with 922 participants that compared therapy, medication or both head to head. No approach was found to be superior at the end of treatment. At the last follow-up, psychotherapy showed greater benefit than medication, a finding that rests on 3 trials in the direct comparison. Combined treatment did better than medication alone in the network analysis but not in the direct comparison, which included 2 trials. The authors wrote: "The scarcity of reported long-term findings hampers definite conclusions."

So the research supports neither the idea that both together are always best nor the idea that combining is pointless.

Who prescribes in Massachusetts?

Massachusetts law names who can. The controlled-substances law lists physicians, nurse practitioners and psychiatric nurse mental health clinical specialists among its practitioners, and a nursing statute says a nurse practitioner or psychiatric nurse mental health clinical specialist may issue written prescriptions. Psychologists are not on the list, and the law that defines the practice of psychology (counseling, psychotherapy, diagnosis and treatment of mental and emotional disorders) contains no prescribing language.

The VA, writing for a national audience, says a psychiatrist often prescribes antidepressants for PTSD, and that many other types of providers can too, including a family provider and some nurses and physician assistants. The differences between these professions are set out in psychologist, psychiatrist or counselor.

How does this work with Dr. Rabin?

Dr. Rabin is a licensed clinical psychologist. She does not prescribe, and she can coordinate with a prescriber if medication is part of your care.

Her trauma therapy is psychodynamic, attachment-based, trauma-informed and mindfulness-based. That approach is not one of the three therapies the VA/DoD guideline recommends over medication. Psychodynamic therapy has been studied much less for PTSD, and both U.S. guidelines find insufficient evidence to recommend for or against it.

This guide makes no claim about whether she offers any named trauma-focused protocol. You can ask on a free consultation of about 15 minutes, requested through the contact page, whether she offers one or would refer you. Fees are on the fees and insurance page.

Keep reading

Sources

Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.

Frequently Asked Questions

How long do PTSD medications take to work?

Of the three antidepressants it lists as recommended for PTSD, the VA says: "You may start to feel better in about 4-6 weeks. You will need to keep taking the medication to keep getting the benefits." It lists possible mild to moderate side effects such as upset stomach, sweating, headache and dizziness, and says some people have sexual side effects. Take questions about your own medicine to your prescriber.

Do antidepressants carry an FDA warning?

Yes. The boxed warning on the current sertraline label begins: "Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies." It tells prescribers to monitor all antidepressant-treated patients closely. If you notice thoughts of suicide, tell your prescriber, and call or text 988, or call 911 in an emergency.

Do you have to describe the trauma to be prescribed medication?

The VA says you will not need to talk about the details of your trauma. Your provider may ask for some basic information when you first meet, such as the type of trauma and when it happened. What therapy asks differs by treatment, as do you have to talk about what happened in trauma therapy? explains.

Can I see Dr. Rabin while another clinician prescribes my medication?

Dr. Rabin does not prescribe, and she can coordinate with a prescriber. Whether her approach fits what you are dealing with is a question for the consultation call. Tell each clinician what the other is providing, and take questions about the medicine itself to the person who prescribes it. VA/DoD finds insufficient evidence for or against combining therapy and medication for PTSD.

Wondering whether therapy would help?

A short conversation can help you decide. Dr. Rebecca Rabin, PsyD offers a free 15-minute consultation to talk through what you are facing and whether therapy with her, or a different kind of help, is the right next step.

Schedule a Free 15-Minute Phone Consultation