Objective: Clinical practice guidelines for the pharmacological treatment of post-traumatic stress disorder (PTSD) do not support the use of benzodiazepines and cite insufficient evidence to recommend mood stabilisers.  Although guidelines previously recommended second-generation antipsychotics as adjunct medication, recent research findings have also brought this recommendation into question.  This study aimed to determine which characteristics of veterans with diagnosed PTSD were associated with receiving prescriptions for benzodiazepines and mood stabilisers and second-generation antipsychotics.

Methods: The survey responses of 482 veterans with PTSD were combined with prescription information from the US Veterans Affairs national pharmacy databases.  The researchers assessed the use of eight classes of psychotropics prescribed for patients with PTSD in the year after a new PTSD diagnosis.  Multivariate logistic regressions identified demographic characteristics, symptom severity, co-occurring psychiatric diagnoses, health service use and attitudinal characteristics associated with prescribing of benzodiazepines, second-generation antipsychotics and mood stabilisers.

Results: In the absence of a clearly indicated co-occurring psychiatric diagnosis, long-term benzodiazepines were prescribed to 14%, second-generation antipsychotics to 15%, and mood stabilisers to 18% of veterans with PTSD.  Benzodiazepine prescribing was associated with symptoms of insomnia.  Having a mental health inpatient stay (odds ratio (OR) = 8.01; p less than 0.001) and at least one psychotherapy visit (OR = 5.37; p less than 0.001) were predictors of being prescribed a second-generation antipsychotic.  Reporting more symptom severity (OR = 1.84; p less than 0.001) and fewer alcohol use problems (OR = 0.36; p less than 0.03) predicted being prescribed a mood stabiliser.

Conclusions: Prescribing patterns appeared generally consistent with treatment guidelines.  Notable exceptions and areas worthy of future attention are discussed.