WHO Guidelines for the Management of Conditions Specifically Related to Stress

Posttraumatic stress disorder (recommendations 14–17)

14. Posttraumatic stress disorder (PTSD): psychological interventions – adults
Scoping question 14: For adults with posttraumatic stress disorder (PTSD), do psychological interventions, when compared to treatment as usual, waiting list or no treatment, result in reduction of symptoms, improved functioning/quality of life, presence of disorder or adverse effects?

Recommendation 14
Individual or group cognitive -behavioural therapy (CBT) with a trauma focus, eye movement desensitization and reprocessing (EMDR) or stress management should be considered for adults with PTSD.
Strength of recommendation: standard
Quality of evidence: moderate for individual CBT, EMDR; low for group CBT, stress management

15. Posttraumatic stress disorder (PTSD): psychological interventions – children and adolescents
Scoping question 15: For children and adolescents with posttraumatic stress disorder (PTSD), do psychological interventions, when compared to treatment as usual, waiting list or no treatment, result in a reduction of symptoms, improved functioning/quality of life, presence of disorder or adverse effects?

Recommendation 15
Individual or group cognitive behavioural therapy (CBT) with a trauma focus or eye movement desensitization and reprocessing (EMDR) should be considered for children and adolescents with PTSD.
Strength of recommendation: standard
Quality of evidence: moderate for individual CBT, low for EMDR, very low for group CBT

16. Posttraumatic stress disorder (PTSD): pharmacological interventions – adults
Scoping question 16: For adults with posttraumatic stress disorder (PTSD), do tricyclic antidepressants (TCAs) or selective serotonin re-uptake inhibitors (SSRIs), when compared to treatment as usual, waiting list or no treatment, result in reduction of symptoms, improved functioning/quality of life, presence of disorder or adverse effects?

Recommendation 16
Selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) should not be offered as the first line of treatment for posttraumatic stress disorder in adults.
SSRIs and TCAs should be considered if:
(a) stress management, CBT with a trauma focus and EMDR have failed or are not available;
or
(b) if there is co-morbid moderate–severe depression.
Strength of recommendation: standard
Quality of evidence: low

17. Posttraumatic stress disorder (PTSD): pharmacological interventions – children and adolescents
Scoping question 17: For children and adolescents with posttraumatic stress disorder (PTSD), do antidepressants, when compared to treatment as usual, waiting list or no treatment, result in reduction of symptoms, improved functioning/quality of life, presence of disorder or adverse effects?

Recommendation 17
Antidepressants should not be used to manage PTSD in children and adolescents.
Strength of recommendation: strong
Quality of evidence: very low

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