创伤后应激障碍药物治疗的研究进展
Research Progress in Pharmacological Treatment of Post-Traumatic Stress Disorder
DOI: 10.12677/ap.2025.159532, PDF,    科研立项经费支持
作者: 柯 苹：空军杭州疗养院疗养四区药械科，江苏 南京；王葛阳, 欧阳刘宇：海军军医大学基础医学院，上海；余鸿璋*：海军军医大学心理系航海心理学教研室，上海
关键词: 创伤后应激障碍；药物治疗；选择性5-羟色胺再摄取抑制；谷氨酸能调节剂；Post-Traumatic Stress Disorder； Pharmacological Treatment； Selective Serotonin Reuptake Inhibitors； Glutamatergic Modulators
摘要: 创伤后应激障碍(Post-Traumatic Stress Disorder, PTSD)是一种与创伤暴露相关的高致残性精神障碍，药物治疗在其综合干预中发挥关键作用。本文系统综述了PTSD药物治疗的研究进展，包括传统药物的临床应用与争议、新兴药物及疗法的突破性成果，以及未来研究方向。传统治疗中，选择性5-羟色胺再摄取抑制剂(SSRIs)作为一线药物，其疗效分层与个体化应用逐渐明晰，舍曲林与帕罗西汀在症状改善上各有侧重，存在明确的剂量–效应关系及生物标志物预测线索；二线药物与辅助药物的应用需严格限定适应症状。新兴领域中，3,4-亚甲基二氧甲基苯丙胺(MDMA)辅助治疗通过多重机制实现临床转化，谷氨酸能调节剂、神经甾体等靶向新通路的药物展现出独特优势。未来研究需聚焦生物标志物指导的精准治疗、联合治疗策略优化及特殊人群治疗探索，以应对当前药物完全缓解率低、个体差异显著等挑战，推动PTSD治疗迈向精准化、多靶点协同的新时代。
Abstract: Post-traumatic stress disorder (PTSD) is a highly disabling mental disorder associated with trauma exposure, and pharmacotherapy plays a crucial role in its comprehensive intervention. This article systematically reviews the research progress in pharmacological treatment of PTSD, including the clinical application and controversies of traditional drugs, breakthroughs in emerging drugs and therapies, as well as future research directions. In traditional treatment, selective serotonin reuptake inhibitors (SSRIs) serve as first-line drugs, with their efficacy stratification and individualized application becoming increasingly clear. Sertraline and paroxetine have different focuses in symptom improvement, with clear dose-effect relationships and biomarker prediction clues. The application of second-line drugs and adjuvant drugs needs to be strictly limited to specific indications. In the emerging field, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy has achieved clinical transformation through multiple mechanisms, and drugs targeting new pathways such as glutamatergic modulators and neurosteroids have shown unique advantages. Future research should focus on biomarker-guided precision treatment, optimization of combination therapy strategies, and exploration of treatment in special populations to address challenges such as low complete remission rates and significant individual differences of current drugs, promoting PTSD treatment towards an era of precision and multi-target synergy.
文章引用：柯苹, 王葛阳, 欧阳刘宇, 余鸿璋 (2025). 创伤后应激障碍药物治疗的研究进展. 心理学进展, 15(9), 422-430. https://doi.org/10.12677/ap.2025.159532

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