Post-Traumatic Stress Disorder in Women

Epidemiological and Treatment Issues

Abstract

Although women are exposed to proportionately fewer traumatic events in their lifetime than men, they have a higher lifetime risk of post-traumatic stress disorder (PTSD). In addition to gender-differential rates of rape and sexual assault, including greater exposure to intimate partner violence, the preponderance of PTSD in women may be attributable to factors other than trauma type, such as sensitisation of stress hormone systems in response to early adverse experiences, inherent neuroendocrine factors, subjective interpretation of the event, and peritraumatic dissociation. Women with PTSD arguably experience a greater symptom burden, longer course of illness and have worse quality-of-life outcomes than men. An expanding knowledge base of the psychobiological alterations in PTSD is providing stimulus for the development of improved pharmacological and psychosocial treatment options. Recent randomised controlled studies conducted in large samples of women with chronic PTSD indicate that: (i) SSRIs have efficacy on all three symptom clusters of PTSD and should be used as first-line pharmacotherapy; and (ii) cognitive behavioural strategies (e.g. prolonged exposure treatment and cognitive processing) are effective in sexually and non-sexually assaulted women. Studies also suggest that female gender may be associated with better response rates to pharmacotherapy. Emerging empirical data on the potential usefulness of antiadrenergic agents and preventive cognitive behavioural treatments in managing acute trauma reactions and stemming the emergence of PTSD are paving the way for further work in this area. However, additional innovative treatments are needed for traumatised women and for female children/adolescents presenting with acute stress reactions and PTSD.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Text revision. 4th ed. Washington, DC: American Psychiatric Association, 2000

    Google Scholar 

  2. 2.

    Norris FH, Perilla JL, Ibanez GE, et al. Sex differences in symptoms of posttraumatic stress: does culture play a role? J Trauma Stress 2001; 14(1): 7–28

    Article  Google Scholar 

  3. 3.

    Fullerton CS, Ursano RJ, Epstein RS, et al. Gender differences in posttraumatic stress disorder after motor vehicle accidents. Am J Psychiatry 2001; 158(9): 1486–91

    PubMed  CAS  Article  Google Scholar 

  4. 4.

    Zlotnick C, Zimmerman M, Wolfsdorf BA, et al. Gender differences in patients with posttraumatic stress disorder in general psychiatric practice. Am J Psychiatry 2001; 158(11): 1923–5

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Green B. Post-traumatic stress disorder: symptom profiles in men and women. Curr Med Res Opin 2003; 19(3): 200–4

    PubMed  Article  Google Scholar 

  6. 6.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-III. 3rd ed. Washington, DC: American Psychiatric Association, 1980

    Google Scholar 

  7. 7.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-III-R. 3rd ed., rev. Washington, DC: American Psychiatric Association, 1987

    Google Scholar 

  8. 8.

    Breslau N, Davis GC, Peterson EL, et al. Psychiatric sequelae of post-traumatic stress disorder in women. Arch Gen Psychiatry 1997; 54: 81–7

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998; 55: 626–32

    PubMed  CAS  Article  Google Scholar 

  10. 10.

    Norris FH. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol 1992; 60: 409–18

    PubMed  CAS  Article  Google Scholar 

  11. 11.

    Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52: 1048–60

    PubMed  CAS  Article  Google Scholar 

  12. 12.

    Stein MB, Walker JR, Hazen AL, et al. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 1997; 154: 1114–9

    PubMed  CAS  Google Scholar 

  13. 13.

    Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med 2002; 5(1): 34–40

    PubMed  Google Scholar 

  14. 14.

    Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000; 68: 748–66

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Breslau N, Davis GC, Andreski P, et al. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 1991; 48: 216–22

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Heizer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population: findings of the epidemiologic catchment area survey. N Engl J Med 1987; 317: 1630–4

    Article  Google Scholar 

  17. 17.

    Davidson JR, Hughes D, Blazer DG, et al. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 1991; 21: 713–21

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Rosenman S. Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Wel1being. Aust N Z J Psychiatry 2002; 36(4): 515–20

    PubMed  Article  Google Scholar 

  19. 19.

    Acierno R, Resnick H, Kilpatrick DG, et al. Risk factors for rape, physical assault, and posttraumatic stress disorder in women: examination of differential multivariate relationships. J Anxiety Disord 1999; 13(6): 541–63

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Stein MB, Walker JR, Forde DR. Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther 2000; 38: 619–28

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Tolin DF, Foa EB. Gender and PTSD: a cognitive model. In: Kimerling R, Ouimette P, Wolfe J, editors. Gender and PTSD. New York: The Guilford Press, 2002: 305–34

    Google Scholar 

  22. 22.

    Holbrook TL, Hoyt DB, Stein MB, et al. Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men. J Trauma 2002; 53: 882–8

    PubMed  Article  Google Scholar 

  23. 23.

    Blanchard EB, Hickling EJ, Mitnick N, et al. The impact of severity of physical injury and perception of life threat in the development of post-traumatic stress disorder in motor vehicle accident victims. Behav Res Ther 1995; 33: 529–34

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Shalev AY, Peri T, Canetti L, et al. Predictors of PTSD in injured trauma survivors: a prospective study. Am J Psychiatry 1996; 153: 219–25

    PubMed  CAS  Google Scholar 

  25. 25.

    Ozer EJ, Best SR, Lipsey TL, et al. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003; 129(1): 52–72

    PubMed  Article  Google Scholar 

  26. 26.

    Engelhard IM, van den Hout MA, Kindt M, et al. Peritraumatic dissociation and posttraumatic stress after pregnancy loss: a prospective study. Behav Res Ther 2003; 41: 67–8

    PubMed  Article  Google Scholar 

  27. 27.

    Thompson MP, Kingree JB. The frequency and impact of violent trauma among pregnant substance abusers. Addict Behav 1998; 23: 257–62

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Josephs L. Women and trauma: a contemporary psychodynamic approach to traumatization for patients in the OB/GYN psychological consultation clinic. Bull Menninger Clin 1996; 60(1): 22–39

    PubMed  CAS  Google Scholar 

  29. 29.

    Reynolds JL. Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. CMAJ 1997; 156(6): 831–5

    PubMed  CAS  Google Scholar 

  30. 30.

    Söderquist J, Wijma K, Wijma B. Traumatic stress in late pregnancy. J Anxiety Disord 2004; 18: 127–42

    PubMed  Article  Google Scholar 

  31. 31.

    Wijma K, Söderquist J, Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study. J Anxiety Disord 1997; 11(6): 587–97

    PubMed  CAS  Article  Google Scholar 

  32. 32.

    Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth. Br J Clin Psychol 2000; 39: 35–51

    PubMed  Article  Google Scholar 

  33. 33.

    Cohen MM, Ansara D, Schei B, et al. Posttraumatic stress disorder after pregnancy, labor, and delivery. J Womens Health (Larchmt) 2004; 13(3): 315–24

    Article  Google Scholar 

  34. 34.

    Chander G, McCaul ME. Co-occurring psychiatric disorders in women with addictions. Obstet Gynecol Clin North Am 2003; 30(3): 469–81

    PubMed  Article  Google Scholar 

  35. 35.

    Sonne SC, Back SE, Zuniga CD, et al. Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder. Am J Addict 2003; 12(5): 412–23

    PubMed  Google Scholar 

  36. 36.

    Brady KT, Killeen TK, Brewerton T, et al. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry 2000; 61 Suppl. 7: 22–31

    Google Scholar 

  37. 37.

    Loveland Cook CA, Flick LH, Homan SM, et al. Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment. Obstet Gynecol 2004; 103(4): 710–7

    PubMed  Article  Google Scholar 

  38. 38.

    Moylan PL, Jones HE, Haug NA, et al. Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD. Addict Behav 2001; 26: 469–74

    PubMed  CAS  Article  Google Scholar 

  39. 39.

    Seng JS, Oakley DJ, Sampseile CM, et al. Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol 2001; 97(1): 17–22

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Neuberg M, Pawlosek W, Lopuszanski M, et al. The analysis of the course of pregnancy, delivery and postpartum among women touched by flood disaster in Kotlin Klodzski in July 1997. inekol Pol 1998; 69(12): 866–70

    CAS  Google Scholar 

  41. 41.

    Foa EB, Dancu CV, Hembree EA, et al. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol 1999; 67: 194–200

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Oquendo MA, Friend JM, Halbersham B, et al. Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry 2003; 160(3): 580–2

    PubMed  Article  Google Scholar 

  43. 43.

    Frayne SM, Seaver MR, Loveland S, et al. Burden of medical illness in women with depression and posttraumatic stress disorder. Arch Intern Med 2004; 164: 1306–12

    PubMed  Article  Google Scholar 

  44. 44.

    Escalona R, Achilles G, Waitzkin H, et al. PTSD and somatization in women treated at a VA primary care clinic. Psychosomatics 2004; 45: 291–6

    PubMed  Article  Google Scholar 

  45. 45.

    Laffaye C, Kennedy C, Stein MB. Post-traumatic stress disorder and health-related quality of life in female victims of intimate partner violence. Violence Vict 2003; 18(2): 227–38

    PubMed  Article  Google Scholar 

  46. 46.

    Walker EA, Katon W, Russo J, et al. Health care costs associated with posttraumatic stress disorder in women. Arch Gen Psychiatry 2003; 60: 369–74

    PubMed  Article  Google Scholar 

  47. 47.

    Boscarino JA, Galea S, Ahern J, et al. Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City. Int J Emerg Ment Health 2002; 4(3): 143–55

    PubMed  Google Scholar 

  48. 48.

    Ullman SE, Brecklin LR. Sexual assault history and health-related outcomes in a national sample of women. Psychol Women Q 2003; 27: 46–57

    Article  Google Scholar 

  49. 49.

    Rapaport MH, Endicott J, Clary CM. Posttraumatic stress disorder and quality of life: results across 64 weeks of sertraline treatment. J Clin Psychiatry 2002; 63(1): 59–65

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    Zatzick DF, Weiss DS, Marmar CR, et al. Posttraumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans. Mil Med 1997; 162: 661–5

    PubMed  CAS  Google Scholar 

  51. 51.

    Wolfe J, Kimerling R. Gender issues in the assessment of posttraumatic stress disorder. In: Wilson J, Keane TM, editors. Assessing psychological trauma and PTSD. New York (NY): Guilford, 1997: 192–238

    Google Scholar 

  52. 52.

    Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994; 151: 1132–6

    PubMed  CAS  Google Scholar 

  53. 53.

    Straus M, Hamby SL, Boney-McCoy SB, et al. The Revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data. J Fam Issues 1996; 17: 283–316

    Article  Google Scholar 

  54. 54.

    Blake DD, Weathers FW, Nagy LM, et al. The development of a clinician-administered PTSD scale. J Trauma Stress 1995; 8: 75–90

    PubMed  CAS  Article  Google Scholar 

  55. 55.

    Davidson JR, Colket JT. The eight-item treatment-outcome post-traumatic stress disorder scale: a brief measure to assess treatment outcome in post-traumatic stress disorder. Int Clin Psychopharmacol 1997; 12: 41–5

    PubMed  CAS  Article  Google Scholar 

  56. 56.

    Connor KM, Davidson JR. SPRINT: a brief global assessment of post-traumatic stress disorder. Int Clin Psychopharmacol 2001; 16: 279–84

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Guy W. Clinical global impressions: NCDEU assessment manual. Psychopharmacology 1976, 222

  58. 58.

    Davidson JR, Book SW, Colket JT, et al. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med 1997; 27: 153–60

    PubMed  CAS  Article  Google Scholar 

  59. 59.

    Weiss D, Marmar C. The impact of events scale: revised. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: Guildford, 1997

    Google Scholar 

  60. 60.

    Rasmusson AM, Vythilingam M, Morgan III CA. The neuroendocrinology of posttraumatic stress disorder. CNS Spectrums 2003; 8(9): 651–67

    PubMed  Google Scholar 

  61. 61.

    Ogilvie KM, Rivier C. Gender difference in hypothalamic-pituitary-adrenal axis response to alcohol in the rat: activational role of gonadal steroids. Brain Res 1997; 766: 19–28

    PubMed  CAS  Article  Google Scholar 

  62. 62.

    Rauch SAM, Cahill SP. Treatment and prevention of posttraumatic stress disorder. Primary Psychiatry 2003; 10(8): 60–5

    Google Scholar 

  63. 63.

    Foa EB, Rothbaum BO, Riggs D, et al. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychology 1991; 59: 715–23

    CAS  Article  Google Scholar 

  64. 64.

    Resick PA, Nishith P, Weaver TL, et al. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol 2002; 70: 867–79

    PubMed  Article  Google Scholar 

  65. 65.

    Hembree EA, Foa EB. Posttraumatic stress disorder: psychological factors and psychosocial interventions. J Clin Psychiatry 2000; 61 Suppl. 7: 33–9

    Google Scholar 

  66. 66.

    Rothbaum BO. A controlled study of eye movement desensitization and reprocessing for post-traumatic stress disordered sexual assault victims. Bull Menninger Clin 1997; 61: 317–34

    PubMed  CAS  Google Scholar 

  67. 67.

    Taylor S, Thordarson DS, Maxfield L, et al. Efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, relaxation training, and EMDR. J Consult Clin Psychology 2003; 71: 330–8

    Article  Google Scholar 

  68. 68.

    Martenyi F, Brown EB, Zhang H, et al. Fluoxetine versus placebo in posttraumatic stress disorder. J Clin Psychiatry 2002; 63: 199–206

    PubMed  CAS  Article  Google Scholar 

  69. 69.

    Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder. Br J Psychiatry 1999; 175: 17–22

    PubMed  CAS  Article  Google Scholar 

  70. 70.

    Barnett SD, Tharwani HM, Hertzberg MA, et al. Tolerability of fluoxetine in posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26(2): 363–7

    PubMed  CAS  Article  Google Scholar 

  71. 71.

    Brady KT, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder. JAMA 2000; 283(14): 1837–44

    PubMed  CAS  Article  Google Scholar 

  72. 72.

    Davidson JRT, Rothbaum BO, van der Kolk B, et al. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 2001; 58: 485–92

    PubMed  CAS  Article  Google Scholar 

  73. 73.

    Brady KT, Clary CM. Affective and anxiety comorbidity in post-traumatic stress disorder treatment trials of sertraline. Compr Psychiatry 2003; 44(5): 360–9

    PubMed  Article  Google Scholar 

  74. 74.

    Marshall RD, Beebe KL, Oldham M, et al. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry 2001; 158: 1982–8

    PubMed  CAS  Article  Google Scholar 

  75. 75.

    Tucker P, Zaninelli R, Yehuda R, et al. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry 2001; 62: 860–8

    PubMed  CAS  Article  Google Scholar 

  76. 76.

    Ruggiero L, Pitts CD, Dillingham K, et al. A flexible-dose study of paroxetine in the treatment of PTSD [poster]. 154th Annual Meeting of the American Psychiatric Association; 2001 May 5–10; New Orleans

  77. 77.

    Stein DJ, Davidson J, Seedat S, et al. Paroxetine in the treatment of post-traumatic stress disorder: pooled analysis of placebocontrolled studies. Expert Opin Pharmacother 2003; 4(10): 829–38

    Article  Google Scholar 

  78. 78.

    Vermetten E, Vythilingam M, Southwick SM, et al. Long-term treatment with paroxetine increases verbal declarative memory and hippocampal volume in posttraumatic stress disorder. Biol Psychiatry 2003; 54: 693–702

    PubMed  CAS  Article  Google Scholar 

  79. 79.

    Gilbertson MW, Shenton ME, Ciszewski A, et al. Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nat Neurosci 2002; 5: 1242–7

    PubMed  CAS  Article  Google Scholar 

  80. 80.

    Bonne O, Brande D, Gilboa A, et al. Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD. Am J Psychiatry 2001; 158: 1248–51

    PubMed  CAS  Article  Google Scholar 

  81. 81.

    Schoenfeld FB, Marmar CR, Neylan TC. Current concepts in pharmacotherapy for posttraumatic stress disorder. Psychiatr Serv 2004; 55: 519–31

    PubMed  Article  Google Scholar 

  82. 82.

    Davidson J, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry 1990; 47(3): 259–66

    PubMed  CAS  Article  Google Scholar 

  83. 83.

    Kosten TR, Frank JB, Dan E, et al. Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. J Nerv Ment Dis 1991; 179(6): 366–70

    PubMed  CAS  Article  Google Scholar 

  84. 84.

    Reist C, Kauffman CD, Haier RJ, et al. A controlled trial of desipramine in 18 men with posttraumatic stress disorder. Am J Psychiatry 1989; 146(4): 513–6

    PubMed  CAS  Google Scholar 

  85. 85.

    Shestatzky M, Greenberg D, Lerer B. A controlled trial of phenelzine in posttraumatic stress disorder. Psychiatry Res 1988; 24(2): 149–55

    PubMed  CAS  Article  Google Scholar 

  86. 86.

    Baker DG, Diamond BI, Gillette G, et al. A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology 1995; 122: 386–9

    PubMed  CAS  Article  Google Scholar 

  87. 87.

    Katz RJ, Lott MH, Arbus P, et al. Pharmacotherapy of posttraumatic stress disorder with a novel psychotropic. Anxiety 1994; 1: 169–74

    PubMed  Google Scholar 

  88. 88.

    Neal LA, Shapland W, Fox C. An open trial of moclobemide in the treatment of post-traumatic stress disorder. Int Clin Psychopharmacol 1997; 12(4): 231–7

    PubMed  CAS  Article  Google Scholar 

  89. 89.

    Davidson JRT, Weisler RH, Butterfield MI, et al. Mirtazapine vs placebo in posttraumatic stress disorder: a pilot trial. Biol Psychiatry 2003; 53: 188–91

    PubMed  CAS  Article  Google Scholar 

  90. 90.

    Hertzberg MA, Feldman ME, Beckham JC, et al. Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design. J Clin Psychopharmacol 1996; 16: 294–8

    PubMed  CAS  Article  Google Scholar 

  91. 91.

    Hidalgo R, Hertzberg MA, Mellman T, et al. Nefazodone in posttraumatic stress disorder: results from six open-label trials. Int Clin Psychopharmacol 1999; 14: 61–8

    PubMed  CAS  Article  Google Scholar 

  92. 92.

    Post RM, Weiss SR, Smith M, et al. Kindling versus quenching: implications for the evolution and treatment of posttraumatic stress disorder. Ann N Y Acad Sci 1997; 821: 285–95

    PubMed  CAS  Article  Google Scholar 

  93. 93.

    Albucher RC, Liberzon I. Psychopharmacological treatment in PTSD: a critical review. J Psychiatr Res 2002; 36: 355–67

    PubMed  Article  Google Scholar 

  94. 94.

    Berlant J, van Kammen DP. Open-label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: a preliminary report. J Clin Psychiatry 2002; 63(1): 15–20

    PubMed  CAS  Article  Google Scholar 

  95. 95.

    Hertzberg MA, Butterfield MI, Feldman ME, et al. A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biol Psychiatry 1999; 45: 1226–9

    PubMed  CAS  Article  Google Scholar 

  96. 96.

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

    PubMed  CAS  Google Scholar 

  97. 97.

    Wells BG, Chu CC, Johnson R, et al. Buspirone in the treatment of posttraumatic stress disorder. Pharmacotherapy 1991; 11(4): 340–3

    PubMed  CAS  Google Scholar 

  98. 98.

    Duffy JD, Malloy PF. Efficacy of buspirone in the treatment of posttraumatic stress disorder: an open trial. Ann Clin Psychiatry 1994; 6(1): 33–7

    PubMed  CAS  Article  Google Scholar 

  99. 99.

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

    PubMed  CAS  Article  Google Scholar 

  100. 100.

    Davidson JRT, Pearlstein T, Londborg P, et al. Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week, double-blind, placebo-controlled study. Am J Psychiatry 2001; 158: 1974–81

    PubMed  CAS  Article  Google Scholar 

  101. 101.

    Martenyi F, Brown EB, Zhang H, et al. Fluoxetine vs placebo in prevention of relapse in post-traumatic stress disorder. Br J Psychiatry 2002; 181: 315–20

    PubMed  Article  Google Scholar 

  102. 102.

    Kornstein SG, Schatzberg AF, Thase ME, et al. Gender differences in treatment response to sertraline versus imipramine in chronic depression. Am J Psychiatry 2000; 157: 1445–52

    PubMed  CAS  Article  Google Scholar 

  103. 103.

    Davidson J, Pelton S. Forms of atypical depression and their response to antidepressant drugs. Psychiatry Res 1986; 17: 87–95

    PubMed  CAS  Article  Google Scholar 

  104. 104.

    Nishizawa S, Benkelfat C, Young SN, et al. Differences between males and females in rates of serotonin synthesis in the brain. Proc Natl Acad Sci U S A 1997; 94: 5308–13

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Quitkin FM, Stewart JW, McGrath PJ, et al. Are there differences between women’s and men’s antidepressant responses? Am J Psychiatry 2002; 157: 1848–54

    Article  Google Scholar 

  106. 106.

    Hildebrandt MG, Steyerberg EW, Stage KB, et al. The Danish University Antidepressant Group. Are gender differences important for the clinical effects of antidepressants? Am J Psychiatry 2003; 160: 1643–50

    Google Scholar 

  107. 107.

    Parker G, Parker K, Austin MP, et al. Gender differences in response to differing antidepressant drug classes: two negative studies. Psychol Med 2003; 33(8): 1473–7

    PubMed  CAS  Article  Google Scholar 

  108. 108.

    Hamilton JA, Grant M, Jensvold MF. Sex and treatment of depression: when does it matter? In: Jensvold F, Halbreich U, Hamilton JA, editors. Psychopharmacology and women: sex, gender and hormones. Washington, DC: American Psychiatric Press, 1996: 241–60

    Google Scholar 

  109. 109.

    Brady KT, Back SE. Gender and PTSD treatment: efficacy and effectiveness. In: Kimmerling R, Ouimette P, Wolfe J, editors. Gender and PTSD. New York (NY): The Guildford Press, 2002: 305–34

    Google Scholar 

  110. 110.

    Tarn LW, Parry BL. Does estrogen enhance the antidepressant effects of fluoxetine? J Affect Disord 2003; 77: 87–92

    Article  CAS  Google Scholar 

  111. 111.

    Frackiewicz EJ, Sramek JJ, Cutler NR. Gender differences in depression and antidepressant pharmacokinetics and adverse events. Ann Pharmacother 2000; 34: 80–8

    PubMed  CAS  Article  Google Scholar 

  112. 112.

    Tucker P, Beebe KL, Burgin C, et al. Paroxetine treatment of depression with posttraumatic stress disorder. J Clin Psychopharmacol 2004; 24(2): 131–40

    PubMed  CAS  Article  Google Scholar 

  113. 113.

    Brady KT, Sonne SC, Roberts JM. Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence. J Clin Psychiatry 1995; 56(11): 502–5

    PubMed  CAS  Google Scholar 

  114. 114.

    Zlotnick C, Najavits LM, Rohsenow DJ, et al. A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: findings from a pilot study. J Subst Abuse Treat 2003; 25(2): 99–105

    PubMed  Article  Google Scholar 

  115. 115.

    Feeny NC, Zoellner LA, Foa EB. Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: a preliminary investigation. J Personal Disord 2002; 16(1): 30–40

    Article  Google Scholar 

  116. 116.

    Rosenberg PB, Mehndiratta RB, Mehndiratta YP, et al. Repetitive transcranial magnetic stimulation of comorbid posttraumatic stress disorder and major depression. J Neuropsychiatry Clin Neurosci 2002; 14(3): 270–6

    PubMed  Article  Google Scholar 

  117. 117.

    Hamner MB, Faldowski RA, Ulmer HG, et al. Adjunctive risperidone treatment in post-traumatic stress disorder: a preliminary controlled trial of effects on comorbid psychotic symptoms. Int Clin Psychopharmacol 2003; 18(1): 1–8

    PubMed  CAS  Article  Google Scholar 

  118. 118.

    Monnelly EP, Ciraulo DA, Knapp C, et al. Low-dose risperidone as adjunctive therapy for irritable aggression in posttraumatic stress disorder. J Clin Psychopharmacol 2003; 23(2): 193–6

    PubMed  CAS  Article  Google Scholar 

  119. 119.

    Butterfield MI, Becker ME, Connor KM, et al. Olanzapine in the treatment of post-traumatic stress disorder: a pilot study. Int Clin Psychopharmacol 2001; 16(4): 197–203

    PubMed  CAS  Article  Google Scholar 

  120. 120.

    Petty F, Brannan S, Casada J, et al. Olanzapine treatment for post-traumatic stress disorder: an open-label study. Int Clin Psychopharmacol 2001; 16(6): 331–7

    PubMed  CAS  Article  Google Scholar 

  121. 121.

    Sattar SP, Ucci B, Grant K, et al. Quetiapine therapy for posttraumatic stress disorder. Ann Pharmacother 2002; 36(12): 1875–8

    PubMed  Article  Google Scholar 

  122. 122.

    Foa EB, Davidson JRT, Frances A. The Expert Consensus Guidelines Series: treatment of posttraumatic stress disorder. J Clin Psychiatry 1999; 60: 1–76

    Google Scholar 

  123. 123.

    Zisook S, Chentsova-Dutton YE, Smith-Vaniz A, et al. Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry 2000; 61(3): 203–8

    PubMed  CAS  Article  Google Scholar 

  124. 124.

    Gillin JC, Smith-Vaniz A, Schnierow B, et al. An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic combat-related posttraumatic stress disorder. J Clin Psychiatry 2001; 62(10): 789–96

    PubMed  CAS  Article  Google Scholar 

  125. 125.

    Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 2003; 159(10): 1777–9

    Article  Google Scholar 

  126. 126.

    Hamner MB, Frueh BC. Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with posttraumatic stress disorder. Int Clin Psychopharmacol 1998; 13: 233–4

    PubMed  CAS  Article  Google Scholar 

  127. 127.

    Otto MW, Hinton D, Korbly NB, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther 2003; 41: 1271–6

    PubMed  Article  Google Scholar 

  128. 128.

    Foa EB. Context in the clinic-CBT and medications: how well do they work alone and in combination? Presented at the 2002 Satellite Research Program, ADAA; 2002 Mar 21; Austin

  129. 129.

    Cahill L, Prins B, Weber M, et al. β-adrenergic activation and memory for emotional events. Nature 1994; 371: 702–4

    PubMed  CAS  Article  Google Scholar 

  130. 130.

    Pitman RK, Sanders KM, Zusman RM, et al. Pilot study of secondary prevention with propranolol. Biol Psychiatry 2003; 51: 189–92

    Article  Google Scholar 

  131. 131.

    Vaiva G, Ducrocq F, Jezequel K, et al. Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biol Psychiatry 2003; 54: 947–9

    PubMed  CAS  Article  Google Scholar 

  132. 132.

    Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry 1996; 57(9): 390–4

    PubMed  CAS  Google Scholar 

  133. 133.

    Schelling G, Briegel J, Roozendaal B, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry 2001; 50: 978–85

    PubMed  CAS  Article  Google Scholar 

  134. 134.

    Robert R, Blakeney PE, Villareal C, et al. Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study. J Am Acad Child Adolesc Psychiatry 1999; 38: 873–82

    PubMed  CAS  Article  Google Scholar 

  135. 135.

    Lee C, Slade P, Lygo V. The influence of psychological debriefing on emotional adaptation in women following early miscarriage: a preliminary study. Br J Med Psychol 1996; 69: 47–58

    PubMed  Article  Google Scholar 

  136. 136.

    Conlon L, Fahy TJ, Conroy R. PTSD in ambulant RTA victims: a randomized controlled trial of debriefing. J Psychosom Res 1999; 46: 37–44

    PubMed  CAS  Article  Google Scholar 

  137. 137.

    Rose S, Brewin CR, Andrews B, et al. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med 1999; 29: 793–9

    PubMed  CAS  Article  Google Scholar 

  138. 138.

    Foa EB, Hearst-Ikeda D, Perry KJ. Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. J Consult Clin Psychol 1995; 63: 948–55

    PubMed  CAS  Article  Google Scholar 

  139. 139.

    Bryant RA, Harvey AG, Sackville T, et al. Treatment of acute stress disorder: a comparison between cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol 1998; 66: 862–6

    PubMed  CAS  Article  Google Scholar 

  140. 140.

    Bryant RA, Sackvi le T, Dang ST, et al. Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry 1999; 156: 1780–6

    PubMed  CAS  Google Scholar 

  141. 141.

    Cohen LS, Rosenbaum JF. Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry 1998; 59 Suppl. 2: 18–28

    CAS  Google Scholar 

  142. 142.

    Bandelow B, Zohar J, Hollander E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 2002; 3: 171–99

    PubMed  Article  Google Scholar 

  143. 143.

    Stowe ZN. Achieving the optimal balance between treatment of maternal depression and infant medication exposure. Symposium Presentation, American Psychiatric Association 157th Annual Meeting; 2004 May 1; New York

  144. 144.

    Ursano RJ, Bell C, Eth S, et al. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry 2004; 161(11 Suppl.): 3–31

    PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygergerg, Cape Town, South Africa The authors do not have an affiliation with or financial interest in any organisation that might pose a conflict of interest

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Soraya Seedat.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Seedat, S., Stein, D.J. & Carey, P.D. Post-Traumatic Stress Disorder in Women. CNS Drugs 19, 411–427 (2005). https://doi.org/10.2165/00023210-200519050-00004

Download citation

Keywords

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Ptsd Symptom
  • Mirtazapine