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Pharmacotherapy for post traumatic stress disorder (PTSD)
Open accessAbstract
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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“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]
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“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
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“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]
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“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]
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“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]
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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)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2006-01-25
- Issue
- 1
- Pages
- CD002795-CD002795
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- 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
- bronze
- doi.org
- 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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