CoChat
Sign Up
Cited by 416Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

PSYCHOTHERAPY VERSUS PHARMACOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER: SYSTEMIC REVIEW AND META-ANALYSES TO DETERMINE FIRST-LINE TREATMENTS: Research Article: Comparison of PTSD Guidelines

Lee, Daniel J., Schnitzlein, Carla W., Wolf, Jonathan P., Vythilingam, Meena, Rasmusson, Ann M., Hoge, Charles W.·2016·Depression and Anxiety
DOI 10.1002/da.22511
Open this paper in CoChat — free account

Abstract

BACKGROUND: Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as first-line treatment. Direct head-to-head comparisons are lacking. METHODS: Systemic review of Medline, EMBASE, PILOTS, Cochrane Central Register of Controlled Trials, PsycINFO, and Global Health Library was conducted without language restrictions. Randomized clinical trials ≥8 weeks in duration using structured clinical interview-based outcome measures, active-control conditions (e.g. supportive psychotherapy), and intent-to-treat analysis were selected for analyses. Independent review, data abstraction, and bias assessment were performed using standardized processes. Study outcomes were grouped around conventional follow-up time periods (3, 6, and 9 months). Combined effect sizes were computed using meta-analyses for medication versus control, medication pre-/posttreatment, psychotherapy versus control, and psychotherapy pre-/posttreatment. RESULTS: Effect sizes for trauma-focused psychotherapies (TFPs) versus active control conditions were greater than medications versus placebo and other psychotherapies versus active controls. TFPs resulted in greater sustained benefit over time than medications. Sertraline, venlafaxine, and nefazodone outperformed other medications, although potential for methodological biases were high. Improvement following paroxetine and fluoxetine treatment was small. Venlafaxine and stress inoculation training (SIT) demonstrated large initial effects that decreased over time. Bupropion, citalopram, divalproex, mirtazapine, tiagabine, and topiramate failed to differentiate from placebo. Aripiprazole, divalproex, guanfacine, and olanzapine failed to differentiate from placebo when combined with an antidepressant. CONCLUSIONS: Study findings support use of TFPs over nontrauma-focused psychotherapy or medication as first-line interventions. Second-line interventions include SIT, and potentially sertraline or venlafaxine, rather than entire classes of medication, such as SSRIs. Future revisions of CPGs should prioritize studies that utilize active controls over waitlist or treatment-as-usual conditions. Direct head-to-head trials of TFPs versus sertraline or venlafaxine are needed.

Integrity signals

Registry

Crossref · 10.1002/da.22511

Cites

74 of 74 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Lee, D. J., Schnitzlein, C. W., Wolf, J. P., Vythilingam, M., Rasmusson, A. M., & Hoge, C. W.
Affiliations
  • Uniformed Services University of the Health Sciences (US)
  • Walter Reed National Military Medical Center (US)
  • United States Marine Corps (US)
  • Boston University (US)
  • Walter Reed Army Institute of Research (US)
Corresponding author
Lee, Daniel J.
ORCID
Venue
Depression and Anxiety
Publisher
Hindawi Limited
Published
2016-04-29
Volume
33
Issue
9
Pages
792-806
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22511
OpenAlex
W2344705609
Cited by
416
References
74
Citations by year
2026: 16 · 2025: 30 · 2024: 47 · 2023: 46 · 2022: 46 · 2021: 41 · 2020: 68 · 2019: 45 · 2018: 39 · 2017: 34 · 2016: 3
FWCI
53.93
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Lincoln (University of Nebraska) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
post-traumatic stress disorder, trauma-focused psychotherapy, pharmacotherapy, sertraline, venlafaxine, paroxetine, stress inoculation training, first-line therapy, active control, antidepressants
MeSH terms
Venlafaxine Hydrochloride, Antidepressive Agents, Combined Modality Therapy, Humans, Piperazines, Psychotherapy, Stress Disorders, Post-Traumatic, Triazoles, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Sertraline

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review