Dr. Patrick Mullen is a psychiatrist in private practice and a Clinical Instructor at the Department of Psychiatry at University of South Carolina School of Medicine. He recently met a patient who points out some of the potential hazards of natural medications.

Strangely enough, there are only two medications FDA-approved for PTSD--Zoloft (sertraline) and Paxil (paroxetine). This is despite the fact that PTSD is a common problem, with a lifetime prevalence of between 5 and 10%, and can be extremely debilitating.

As you can see from this issue's lead article, SSRIs help alleviate core PTSD symptoms, but hardly roar by the placebo response rate in clinical trials. And anytime the placebo effect is this robust, you can predict that psychotherapy will be very effective. This is certainly true in the world of PTSD.

Let's face it, when our patients are in distress, we use whatever meds we think might be helpful, whether the FDA has given its blessing or not. Not a single one of the nostrums discussed in this article is FDA-approved for PTSD, but they are all commonly used when nothing else works.

TCR: Dr. Foa, how common is PTSD? Dr. Foa: The epidemiological studies tell us that 60% of men in the United States and over 50% of women have been traumatized at least once in their lifetime.

Laura Wolfe, M.D., is an adult psychiatrist who works for Kaiser Permanente in Santa Clara, California. Her experience treating a man with PTSD is helpful in understanding the role of SSRIs.

Reviewing the new medications for alcoholism brings us into a pharmacologic netherworld. Nothing is very clear, and when you think you've finally come to a conclusion, a new study comes along to cast a fresh fog over everything.

Guess what: Antabuse (disulfiram) is back in fashion, over a half century after its initial approval by the FDA. You have probably seen some of the infomercials funded by Odyssey Pharmaceuticals and published as supplements by the usual journals.

By now, it is clear that the most effective treatment for alcoholism is consistent attendance at AA (Alcoholics Anonymous) meetings. Not only have outcome studies shown that AA attendance promotes abstinence, but in addition, therapy aimed specifically at encouraging AA attendance has been shown to robustly increase the chances that patients will actually go to meetings and get sponsors (Alcohol Research and Health, 1999;23:93-98).

Dr. Gitlow, let's get right into the issue of benzodiazepines. A typical scenario for many of us in office practice is that we will see a patient recently out of detox who will say, "Well doctor, I have always had terrible anxiety whether I have been drinking or not, I have tried this and I have tried that, and if I can't take something that will help my anxiety, I am sure I am going to start drinking again."