Diagnostic framework #
In a DSM-oriented assessment, symptoms persist for more than 1 month and impair function, with intrusion, avoidance, negative mood/cognitive changes and arousal/reactivity considered. ICD-11 organizes the syndrome differently; record the diagnostic system rather than combining cluster thresholds.
Targeted clinical assessment #
Establish exposure and symptom timing, current threat, dissociation, nightmares, triggers and avoidance. Offer choice and pacing; assess housing, pain, injury and social supports. Directly assess self-harm and substance use. Screening and monitoring tools support, rather than replace, the clinical interview.
Differential diagnosis #
| Alternative / overlap | Discriminator |
|---|---|
| Acute stress response | Duration and course after exposure. |
| Depression and anxiety | Separate pervasive mood/worry from trauma-linked symptoms. |
| Psychosis or dissociation | Clarify flashbacks, awareness, triggers and symptoms outside trauma contexts. |
| Sleep or substance disorder | Independent apnea, intoxication or withdrawal may sustain symptoms. |
Indicated investigations #
| Context | Investigation / assessment |
|---|---|
| Injury, pain or neurological change | Directed physical and neurological assessment. |
| Sleep complaints | Assess apnea, nightmares and other sleep contributors; testing only for an indicated question. |
| Medicine selection | Review bipolar history, interactions, hepatic function and sodium vulnerability. |
Treatment sequence #
View treatment map
- Present needs
Address current danger, practical support and comorbid illness.
- Core treatment
Offer evidence-based trauma-focused psychotherapy such as trauma-focused CBT or EMDR as appropriate.
- Medicine selected
Discuss SSRI treatment such as sertraline, its adverse effects and review plan.
- Persistent illness
Reassess comorbidity and treatment engagement; seek specialist input for complex symptoms.
| Priority | Approach |
|---|---|
| Present needs | Address current danger, practical support and comorbid illness. |
| Core treatment | Offer evidence-based trauma-focused psychotherapy such as trauma-focused CBT or EMDR as appropriate. |
| Medicine selected | Discuss SSRI treatment such as sertraline, its adverse effects and review plan. |
| Persistent illness | Reassess comorbidity and treatment engagement; seek specialist input for complex symptoms. |
Doses & prescribing #
Each prescribing record identifies its population and source jurisdiction; international labeling does not establish Indian approval. The clinician selects treatment after assessment.
Sertraline
Post-traumatic stress disorder
Adults · Immediate-release tablets · Oral · United States product labeling
- Starting dose
- 25 mg once daily for the first week; then 50 mg once daily.
- Titration
- Subsequent increases of 25–50 mg/day no more often than weekly, according to response and tolerability.
- Treatment range / target
- 50–200 mg/day.
- Maximum / limits
- 200 mg/day.
- Trial & duration
- Condition-specific trial and continuation guidance below.
- Monitoring
- Activation, mood switch, suicidality, gastrointestinal/sexual effects; sodium when indicated.
- Population & organ-function adjustments
- Mild hepatic impairment: half starting and maximum doses; moderate/severe hepatic impairment: not recommended.
- Important cautions
- Avoid MAOIs and pimozide; reconcile serotonergic and bleeding-related interactions.
Nonresponse & escalation #
Check that psychotherapy was trauma-focused and delivered with sufficient engagement, and that medication exposure was adequate. Reassess continuing threat, substance use, dissociation and sleep disorders. VA/DoD advises against benzodiazepines for PTSD; a sedative response does not demonstrate treatment of the core disorder.
Maintenance & discontinuation #
Plan how to maintain gains through approaching previously avoided activities and recognizing early deterioration. Medicine duration and tapering should reflect response, recurrence, comorbidity and withdrawal vulnerability; the cited guidance does not define a single schedule for every patient.
Special populations & comorbidity #
Ongoing interpersonal violence, unstable housing, cognitive impairment or language needs change treatment delivery. Pregnancy/lactation requires medicine-specific counseling. Complex presentations may need additional work on engagement, emotional regulation and barriers to trauma-focused care.
Follow-up #
Review impairment, avoidance, nightmares, dissociation, current threat and goals as well as PCL-5 change. Ask about adverse effects and activation during medication titration. Agree how the patient will contact services if distress worsens between appointments.
Clinical pitfalls #
Do not require a detailed trauma narrative during an initial screen. Avoid routine psychologically focused debriefing after trauma. A lower checklist score does not establish that ongoing danger has resolved.
Assessment tools #
Choose the instrument for its intended purpose; interpretation accompanies the linked tool.
Patient discussion #
Open a plain-language explanation
Trauma can leave the alarm system responding as if danger is still present. Care proceeds at an agreed pace and includes practical support.
Further reading #
References · 4
- NICE NG116: PTSD recommendations · United Kingdom · Checked 2026-10-26 · Supports: Treatment sequence; Maintenance & discontinuation; Special populations & comorbidity; Clinical pitfalls
- NIMH: PTSD diagnosis and care · United States · Checked 2026-10-26 · Supports: Diagnostic framework; Targeted clinical assessment; Differential diagnosis; Indicated investigations; Follow-up
- VA National Center for PTSD: Medication guide · United States · Checked 2026-10-26 · Supports: Treatment sequence; Nonresponse & escalation
- Sertraline tablets: indication-specific product dosing · United States label · Checked 2026-10-26 · Supports: Indicated investigations; Special populations & comorbidity; Follow-up; Sertraline — Post-traumatic stress disorder (Immediate-release tablets)