Post-traumatic stress disorder — MSF Clinical guidelines — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Clinical guidelines — Diagnosis and treatment manual › Chapter 11: Mental disorders in adults · Médecins Sans Frontières, Current online edition (updated November 2021)

MSF guidance on recognising and managing PTSD in adults exposed to violence, death or serious harm.

In one sentencePTSD after violence/trauma exposure presents with re-experiencing, avoidance and hypervigilance; manage with psychological intervention and, for severe symptoms, SSRIs (fluoxetine 20 mg, paroxetine 10–20 mg or sertraline 50 mg daily) for 2–3 months post-resolution.

Issuer: Médecins Sans Frontières
Edition: Current online edition (updated November 2021)
Audience: Clinicians in humanitarian and resource-limited settings
Evidence: Expert consensus based on ICD-11
Reviewed: 22 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 22 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF clinical guideline addresses post-traumatic stress disorder (PTSD) in adults following direct exposure to death, serious injury from violence, or severe personal harm such as rape or torture. PTSD is characterised by three main symptom clusters: persistent re-experiencing (intrusive images, flashbacks, distressing dreams), avoidance of trauma-related situations and thoughts, and persistent perceptions of heightened threat (hypervigilance, exaggerated startle reaction, anxiety, insomnia).

Management centres on psychological intervention to reduce suffering and disability. The guideline emphasises reassuring patients that their symptoms are a normal response to an abnormal event, conducting sessions with tact, and allowing patients to control how much they share. Short-term symptomatic treatment (maximum two weeks) may address persistent anxiety or insomnia.

For severe symptoms including obsessive thoughts, pronounced hypervigilance or comorbid depression, pharmacological treatment with selective serotonin reuptake inhibitors is recommended: fluoxetine 20 mg once daily, paroxetine 10–20 mg once daily, or sertraline 50 mg once daily, continued for 2–3 months after symptom resolution before gradual discontinuation.

Key points

For clinicians — doses and thresholds as stated in the guideline

PTSD develops after direct exposure to death, serious injury from violence, or severe personal harm (rape, torture), causing feelings of helplessness and horror
Three diagnostic clusters: persistent re-experiencing (intrusive images, flashbacks, distressing dreams), avoidance of trauma-related stimuli, and persistent perceptions of heightened threat (hypervigilance, exaggerated startle reaction)
Psychological intervention is essential; reassure patients their symptoms are a normal response to an abnormal event
Conduct sessions with tact, listen to the patient, avoid intense questioning about emotions, and let the patient decide how far to go
For persistent anxiety or insomnia, symptomatic treatment may be given for no more than two weeks
For severe symptoms (obsessive thoughts, pronounced hypervigilance, comorbid depression): fluoxetine 20 mg once daily OR paroxetine 10–20 mg once daily OR sertraline 50 mg once daily
Continue pharmacological treatment for 2–3 months after symptoms resolve, then stop gradually
Distinguish immediate transitory symptoms from secondary problems appearing weeks or months after the traumatic event

Pharmacological treatment options for severe PTSD

Table extracted from the guideline

Medication	Dose	Frequency	Duration
Fluoxetine	20 mg	Once daily	Continue for 2–3 months after symptoms resolve, then stop gradually
Paroxetine	10–20 mg	Once daily	Continue for 2–3 months after symptoms resolve, then stop gradually
Sertraline	50 mg	Once daily	Continue for 2–3 months after symptoms resolve, then stop gradually

Source: Médecins Sans Frontières, Post-traumatic stress disorder — MSF Clinical guidelines. Reproduced in summary form.

From the guideline

Verbatim

“It is important to reassure the patient that their symptoms are a normal response to an abnormal event.”

— Médecins Sans Frontières, Post-traumatic stress disorder — MSF Clinical guidelines, Management section (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As someone who has worked with WHO on health and migration, I recognise that PTSD remains underdiagnosed and undertreated across Georgia and the South Caucasus, despite ongoing displacement from Abkhazia and South Ossetia and high rates of domestic violence. This MSF guideline provides a practical, resource-appropriate framework that Georgian primary care physicians can implement immediately: the emphasis on psychological intervention as essential, the clear symptom clusters for diagnosis, and the straightforward SSRI regimens are all feasible within our current health system. The most critical recommendation for our context is that clinicians must reassure patients their symptoms are normal responses to abnormal events—this destigmatises mental health symptoms and encourages help-seeking in a culture where psychological distress is often somatised. The main implementation challenge will be training our primary care workforce in trauma-informed communication skills and ensuring that psychological support services, still scarce outside Tbilisi, are available alongside pharmacological treatment.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026

Applicability

Georgia and the South Caucasus

This guideline is highly relevant for the South Caucasus and Eastern Europe, regions that have experienced armed conflict, displacement, and high rates of gender-based violence. Georgia’s national mental health programme, still developing its capacity for trauma-informed care, would benefit from integrating these evidence-based PTSD management principles into primary and secondary care settings. Implementation would require training clinicians in psychological first aid and trauma-focused interventions, ensuring availability of the recommended SSRIs on essential medicines lists, and establishing referral pathways between general practice and specialist mental health services. In conflict-affected areas of Georgia and neighbouring countries, humanitarian and post-conflict health programmes should prioritise mental health and psychosocial support as outlined in this guidance.

Questions this guideline answers

Quick answers

What defines a traumatic event for PTSD diagnosis?

Direct confrontation with death (witnessing killing or serious injury from violence) or experiencing serious harm that threatens life or physical integrity, such as rape or torture, causing feelings of helplessness and horror.

What are the three main symptom clusters of PTSD?

Persistent re-experiencing (intrusive images, flashbacks, distressing dreams), avoidance of trauma-related situations and thoughts, and persistent perceptions of heightened threat (hypervigilance, exaggerated startle reaction, anxiety, insomnia).

When should pharmacological treatment be initiated for PTSD?

When the patient has severe symptoms including obsessive thoughts, pronounced hypervigilance, or comorbid depression. Treatment options include fluoxetine 20 mg, paroxetine 10–20 mg, or sertraline 50 mg once daily.

How long should symptomatic treatment for anxiety or insomnia be given?

For no more than two weeks if symptoms are persistent. For severe PTSD requiring SSRI treatment, continue for 2–3 months after symptoms resolve, then stop gradually.

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Post-traumatic stress disorder — MSF Clinical guidelines

What this guideline says

Key points

Pharmacological treatment options for severe PTSD

From the guideline