The answer is E. Sertraline
Sertraline is the answer: SSRIs are first-line pharmacotherapy for PTSD, and sertraline and paroxetine are the two agents FDA-approved for it. The 2023 VA/DoD clinical practice guideline gives a strong recommendation for sertraline, paroxetine, or venlafaxine, and only one of those three appears among these options. Expect symptom response over 6 to 8 weeks at an adequate dose, and continue for at least a year in responders.
Note the hierarchy the stem deliberately sets up. The same guideline recommends trauma-focused psychotherapy over pharmacotherapy as the primary treatment — cognitive processing therapy, prolonged exposure, and EMDR carry the strongest evidence base in the field. That is why this patient has already been referred for cognitive processing therapy: medication here is an adjunct to therapy, not a substitute for it, and a question that omitted the referral would have had psychotherapy as its best answer.
The diagnosis rests on duration and on four symptom clusters. After exposure to actual or threatened death, serious injury, or sexual violence, PTSD requires symptoms for more than one month in all four domains: intrusion (memories, nightmares, flashbacks), avoidance of trauma reminders, negative alterations in cognition and mood (detachment, persistent negative beliefs, anhedonia), and alterations in arousal and reactivity (irritability, hypervigilance, exaggerated startle, sleep and concentration problems). Under one month, the diagnosis is acute stress disorder — that single fact separates the two on nearly every exam. Specify with delayed expression if full criteria are not met until at least six months after the trauma.
Sorting the distractors: alprazolam is the trap and the most important wrong answer on this question — benzodiazepines carry a strong recommendation against their use in PTSD; they do not treat the core symptom clusters, they can interfere with the extinction learning that makes exposure-based therapy work, and they add dependence risk in a population with elevated substance use disorder rates; quetiapine and other atypical antipsychotics are not first-line and are reserved for adjunctive use in refractory cases, carrying metabolic burden; bupropion has no established efficacy in PTSD and its activating profile can worsen hyperarousal and insomnia; and prazosin is the most defensible of the wrong answers — an alpha-1 antagonist with a weak recommendation for trauma-related nightmares specifically — but it is a targeted add-on for one symptom, not a treatment for the disorder as a whole, which is what she is asking about.
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