Post Traumatic Stress Disorder (PTSD)

B.C. is a 64-year-old female self-referring for worsening anxiety. Symptoms began after a difficult divorce 2–3 years ago and progressed over the past year to chronic worry, irritability, insomnia, and recurrent panic-like “episodes” with racing heart, arm numbness, and sense of impending doom lasting a few minutes. She has tried lifestyle/OTC measures (including taurine) with minimal benefit and reports an extensive PCP workup for medical causes.

Medication trials include escitalopram 10 mg daily x1 month without improvement, then buspirone titrated up to 15 mg TID with no relief and nausea/bloating. She takes doxepin 6 mg qHS without benefit and uses alprazolam 0.5 mg PRN for sleep and occasional daytime symptoms. She is seeking a more responsive prescriber and feels psychotherapy has not helped.