How to Review PTSD Polypharmacy in Operational Stress Injury Clinics
How should clinicians review and interpret polypharmacy in patients with posttraumatic stress disorder treated in operational stress injury clinics?
Medication burden is high in specialized military-related posttraumatic stress disorder care, and many patients receive several PTSD-indicated medications at the same time. Clinicians need a practical way to review complex regimens and understand which class combinations are common enough to anticipate targeted monitoring and reassessment.
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Count all medications and separate PTSD-indicated from other prescribing
Begin medication reconciliation by documenting both total medications and those specifically prescribed for PTSD. In the study, 98.6% of patients received at least 1 medication, with a mean of 3.69 medications per patient for any condition and 3.04 specifically for PTSD, so separating overall burden from PTSD-directed treatment is clinically important.
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Identify whether antidepressants and hypnotics form the regimen core
Check first for antidepressants and hypnotics, because these were the most frequently prescribed classes for both PTSD and all indications. Among patients prescribed at least 1 antidepressant, 96.4% received it for PTSD, and among those prescribed at least 1 hypnotic, 94.0% received it for PTSD.
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Look for common coprescribing patterns around SSRIs and SNRIs
If the patient is taking an SSRI or SNRI, actively review the classes most often added in the study. The most frequent coprescribed class was hypnotics for both SSRIs and SNRIs, followed by antiadrenergics, antipsychotics, benzodiazepines, and atypical antidepressants, showing that augmentation commonly clusters around sleep and arousal-targeted treatment.
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Interpret higher medication counts as symptom-cluster targeting
When patients are taking multiple PTSD medications, review which symptom domains each agent appears to target rather than treating the regimen as nonspecific overprescribing by default. The authors interpret higher-complexity regimens as attempts to manage sleep disturbance, nightmares, hyperarousal, and mood dysregulation in chronic, refractory PTSD.
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Pay particular attention to sleep-directed prescribing
Review the presence of low-dose trazodone used as a hypnotic, zopiclone, and zolpidem because these were among the most common PTSD-indicated medications. Sleep-directed treatment was especially prominent in this cohort, and nearly all patients prescribed 2 or more hypnotics had them prescribed for PTSD.
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Reassess benzodiazepines and other non-first-line adjuncts cautiously
When benzodiazepines, antipsychotics, or other non-first-line adjunctive agents are present, note that the article describes these as diverging from guideline recommendations but often used selectively in response to clinical complexity. Benzodiazepines were described as often prescribed as needed, suggesting use for acute anxiety, panic, or crisis presentations rather than routine foundational treatment.
Clinical Considerations
- The article describes prescribing prevalence and class intersections, not a validated deprescribing or sequencing protocol.
- Electronic medical record data did not systematically capture prescriber rationale, so the indication for every combination may not be fully explained.
- Observed polypharmacy may partly reflect differences in patient population across sites, and significant site-level variation was present.
- Because the study was conducted in specialized operational stress injury clinics, these patterns may not apply to general psychiatric or community PTSD care.
Bottom Line
In operational stress injury clinics, PTSD polypharmacy should be reviewed as structured symptom-targeted prescribing built most often on antidepressants plus sleep-focused agents, not as antidepressant treatment in isolation.
