Section - Video Lectures

12. Take-Home Messages

Published on April 29, 2026 Certification expiration date: April 29, 2029

David Osser, M.D.

Associate Professor of Psychiatry - Harvard Medical School

Key Points

Prescribe prazosin as a first-line agent for sleep disturbances in PTSD. Ensure correct dosing, and monitor for postural hypotension and dizziness.
Reserve SSRIs for use after antiadrenergic agents. Prefer escitalopram; paroxetine carries a higher burden of sexual dysfunction and weight gain.
Counsel patients against using cannabis for PTSD. Current evidence suggests it is ineffective and potentially harmful.

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Slides and Transcript

Slide 1 of 10

Hello everybody! This is Dr. David Osser again, from Harvard Medical School and the VA in Brockton, Massachusetts. I’m here to present the take-home messages on our algorithm for the treatment of PTSD with medication. I want to thank you for listening to the previous sections of this algorithm and I really appreciate all of your interest in the talks that I’ve given for the Psychopharmacology Institute and lately for this particular talk. So here we go with our take-home messages, my summary and conclusions.

References:

David Osser, M.D.

Take-Home Messages Slide 1 of 10

Slide 2 of 10

First of all, the authors of this algorithm especially Dr. Laura Bajor, the first author of our three publications of this algorithm, we proposed the first time we published it in 2011 that the first-line medication for PTSD featured by symptoms of nightmares and other sleep problems would be prazosin, before starting an SSRI which were the generally recommended first-line treatments for PTSD in just about all other guidelines and algorithms that were out there.

References:

Bajor, L. A., Ticlea, A. N., & Osser, D. N. (2011). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on posttraumatic stress disorder. Harvard Review of Psychiatry, 19(5), 240–258. https://doi.org/10.3109/10673229.2011.614483

Take-Home Messages Slide 2 of 10

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