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Cited by 519Posttraumatic Stress Disorder ResearchSleep and related disordersTraumatic Brain Injury Research

The DOI matches its Crossref record; 284 of the 288 references it cites were found in a registry or an index.

Pharmacotherapy for post traumatic stress disorder (PTSD)

Open access
Stein, Dan J, Ipser, Jonathan C, Seedat, Soraya, Sager, Carli, Amos, Taryn·2006·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002795.pub2PMC PMC6993948
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Abstract

BACKGROUND: Post traumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. OBJECTIVES: To assess the effects of medication for post traumatic stress disorder. SEARCH STRATEGY: We searched the Cochrane Depression, Anxiety and Neurosis Group specialised register (CCDANCTR-Studies) on 18 August 2005, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 4, 2004), MEDLINE (January 1966 to December 2004), PsycINFO (1966 to 2004), and the National PTSD Center Pilots database. Reference lists of retrieved articles were searched for additional studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy for PTSD. DATA COLLECTION AND ANALYSIS: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. MAIN RESULTS: 35 short-term (14 weeks or less) RCTs were included in the analysis (4597 participants). Symptom severity for 17 trials was significantly reduced in the medication groups, relative to placebo (weighted mean difference -5.76, 95% confidence intervals (CI) -8.16 to -3.36, number of participants (N) = 2507). Similarly, summary statistics for responder status from 13 trials demonstrated overall superiority of a variety of medication agents to placebo (relative risk 1.49, 95% CI 1.28 to 1.73, number needed to treat = 4.85, 95% CI 3.85 to 6.25, N = 1272). Medication and placebo response occurred in 59.1% (N = 644) and 38.5% (628) of patients, respectively. Of the medication classes, evidence of treatment efficacy was most convincing for the SSRIs. Medication was superior to placebo in reducing the severity of PTSD symptom clusters, comorbid depression and disability. Medication was also less well tolerated than placebo. A narrative review of 3 maintenance trials suggested that long term medication may be required in treating PTSD. AUTHORS' CONCLUSIONS: Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability. The findings of this review support the status of SSRIs as first line agents in the pharmacotherapy of PTSD, as well as their value in long-term treatment. However, there remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.

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Crossref · 10.1002/14651858.cd002795.pub2

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  • There are strong genetic correlations across PTSD symptom dimensions and efficacious pharmacotherapy for PTSD reduces symptoms across dimensions.

    “While it has long been suggested that different symptom dimensions of PTSD are underpinned by different neurobiological mechanisms 89,90 , it seems that there are strong genetic correlations across PTSD symptom dimensions and that efficacious pharmacotherapy for PTSD reduces symptoms across dimensions 91 .”

    From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [91]

    The Secondary outcome measures section reports significantly reduced scores across all three PTSD symptom clusters with medication, supporting the pharmacotherapy part of the claim. Our copy does not report genetic correlations across symptom dimensions (searched for genetic correlations and heritability), so it does not support that part. (LLM, conf=0.87)

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  • Adjunctive treatments may improve the efficacy of first-line cognitive-based PTSD therapies, which currently show they are effective in approximately 40% of patients.

    “Such adjunctive treatments may improve the efficacy of first-line cognitive-based PTSD therapies, which currently show they are effective in approximately 40% of patients (Bradley et al., 2005; Stein et al., 2006; Ravindran and Stein, 2009).”

    From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Stein et al., 2006

    The Background says cognitive-behavioural and similar psychotherapies are effective for PTSD, and the discussion suggests combined treatment may contribute to psychotherapy outcomes. The paper does not give an approximately 40% effectiveness rate for cognitive-based therapies or establish that adjunctive treatment improves their efficacy. Its reported 38.5% figure is a placebo response rate in medication trials, not a psychotherapy effectiveness rate. (LLM, conf=0.86)

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  • Pharmacological treatments are effective for managing PTSD symptoms but to a lesser degree.

    “Pharmacological treatments are also effective for managing PTSD symptoms but to a lesser degree [9].”

    From Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis (2020) · cites this paper as [9]

    The Authors’ Conclusions say medication can reduce core PTSD symptoms. But the discussion says the review does not directly establish whether medication or psychotherapy has a larger effect, so it does not support the general claim that medication works ‘to a lesser degree.’ The indexed passages provide section labels but no page numbers. (LLM, conf=0.90)

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  • Both the MTV report and a Cochrane review on pharmacological treatment concluded that there is a need for more trials on patients with treatment refractory PTSD, such as many refugees, because SSRI seems to be inadequate for these patients.

    “However, both the MTV report and a Cochrane review on pharmacological treatment concluded that there is a need for more trials on patients with treatment refractory PTSD, such as that of many refugees, because SSRI seems to be inadequate for these patients [7, 16].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [7]

    The review’s discussion (Cochrane Library section; page unavailable) calls for further research on treatment-refractory patients. It does not say that many refugees are treatment-refractory or that SSRIs are inadequate for those patients. Its statement that a short course of SSRIs may be inadequate concerns treatment duration, not that subgroup. (LLM, conf=0.88)

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  • Clinical guidelines for the treatment of PTSD are based on reviews and meta-analyses that mainly include studies on non-refugee PTSD populations.

    “Therefore, clinical guidelines for the treatment of PTSD are based on reviews and meta-analyses, which mainly include studies on non-refugee PTSD populations [4–7].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [7]

    This paper is a systematic review of PTSD pharmacotherapy trials. Its Results (Description of studies; page unavailable) describe most trials by veteran and civilian trauma groups, while Characteristics of included studies identifies a trial of Bosnian refugees. That supports the broad point that the reviewed evidence was not focused on refugees, but the paper does not establish that clinical PTSD guidelines were based on reviews and meta-analyses mainly comprising non-refugee populations. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Citations

Cites

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4 of the 288 references couldn’t be matched to a known paper.

Research works printed but not linked: 25

  1. Rapaport, 2000, Quality of life improvement in PTSD with sertraline treatment: Results of a multicenter, placebo-controlled trial, International Journal of Neuropsychopharmacology, 3, 294
  2. Davidson, 2002, Characterizing the effects of sertraline in post-traumatic stress disorder, Psychological Medicine, 32, 661, 10.1017/S0033291702005469 · DOI
  3. Davidson, 2000, Double-blind, randomized, 28-week continuation study of sertraline and placebo in posttraumatic stress disorder, International Journal of Neuropsychopharmacology, 3, 292
  4. Davidson, 2001, Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study, American Journal of Psychiatry, 158, 1974, 10.1176/appi.ajp.158.12.1974 · DOI
  5. Rapaport, 2002, Posttraumatic stress disorder and quality of life: Results across 64 weeks of sertraline treatment, Journal of Clinical Psychiatry, 63, 59, 10.4088/JCP.v63n0112 · DOI
  6. Davidson, 2004, Treatment of PTSD: A comparison of venlafaxine extended release, sertraline, and placebo [abstract NR521], 157th Annual Meeting of the American Psychiatric Association; 2004 May 1-6; New York, NY, 195
  7. Connor, 2001, Predictors of treatment response in patients with posttraumatic stress disorder, Progress in Neuro-Psychopharmacology and Biological Psychiatry, 25, 337, 10.1016/S0278-5846(00)00163-9 · DOI
  8. Amital, 2000, A placebo-controlled study of sertraline in post traumatic stress disorder, International Journal of Neuropsychopharmacology, 3, 269
  9. Reist, 1995, REM latency, dexamethasone suppression test, and thyroid releasing hormone stimulation test in posttraumatic stress disorder, Progress in Neuropsychopharmacology and Biological Psychiatry, 19, 433, 10.1016/0278-5846(95)00024-P · DOI
  10. Alderson, 2004, Assessment of study quality
  11. Davidson, 1993, Predicting response to amitriptyline in posttraumatic stress disorder, American Journal of Psychiatry, 150, 1024, 10.1176/ajp.150.7.1024 · DOI
  12. Dominiak, 1992, Psychopharmacology of the abused, 81
  13. Hamner, 1997, Buspirone potentiation of antidepressants in the treatment of PTSD, Depression and Anxiety, 5, 137, 10.1002/(SICI)1520-6394(1997)5:3<137::AID-DA6>3.0.CO;2-B · DOI
  14. Hertzberg, 1999, A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder, Biological Psychiatry, 45, 1226, 10.1016/S0006-3223(99)00011-6 · DOI
  15. Kolb, 1984, Propranolol and clonidine in the treatment of the chronic post-traumatic stress disorders of war, 98
  16. Lowenstein, 1988, Open trial of clonazepam in the treatment of post traumatic stress symptoms in multiple personality disorder, Dissociation, 1, 3
  17. Marshall, 1998, Pharmacotherapy in the treatment of posttraumatic stress disorder and other trauma-related disorders, 133
  18. Milanes, 1984, Phenelzine treatment of post-Vietnam stress syndrome, VA Practitioner, 1, 40
  19. Guideline Development Group, 2005, Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care, 26
  20. Otto, 1996, Cognitive-behavioral and pharmacological perspectives on the treatment of post traumatic stress disorder, 219
  21. Rapaport, 2002, Posttraumatic stress disorder and quality of life: Results across 64 weeks of sertraline treatment, Journal of Clinical Psychiatry, 63, 59, 10.4088/JCP.v63n0112 · DOI
  22. Rubin MR Solt V Chen C-J Anafranil's effect on the obsessions and sleep in PTSD Proceedings and Abstracts of the 146th Annual Meeting of the American Psychiatric Association, San Francisco, CA 1993 102
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Metadata

Authors
Stein, D. J., Ipser, J. C., Seedat, S., Sager, C., & Amos, T.
Affiliations
  • University of Cape Town (ZA)
  • Stellenbosch University (ZA)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2006-01-25
Issue
1
Pages
CD002795-CD002795
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002795.pub2
PMC
PMC6993948
OpenAlex
W1530873853
Cited by
519
References
288
Citations by year
2026: 5 · 2025: 12 · 2024: 20 · 2023: 21 · 2022: 23 · 2021: 25 · 2020: 24 · 2019: 26 · 2018: 20 · 2017: 22 · 2016: 54 · 2015: 29 · 2014: 31 · 2013: 33 · 2012: 27
FWCI
3.43
Type
journal article
Language
en
Update notices
new_version (2022-03-02)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Medical Research Council
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Keywords
post-traumatic stress disorder, pharmacotherapy, selective serotonin reuptake inhibitors, antidepressants, symptom severity, comorbid depression, anxiety comorbidity, treatment response, placebo response, adverse drug reactions, treatment discontinuation, PTSD symptom clusters
MeSH terms
Antidepressive Agents, Humans, Psychotropic Drugs, Stress Disorders, Post-Traumatic, Randomized Controlled Trials as Topic

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