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Cited by 216Posttraumatic Stress Disorder ResearchSleep and related disordersMigration, Health and Trauma

Evidence-based pharmacotherapy of post-traumatic stress disorder (PTSD)

Open access
Ipser, Jonathan C., Stein, Dan J.·2012·The International Journal of Neuropsychopharmacology
DOI 10.1017/s1461145711001209
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Abstract

Post-traumatic stress disorder (PTSD) is a prevalent and disabling disorder. Recognition of neurobiological abnormalities associated with this condition suggests the potential efficacy of medication in its treatment. Nevertheless, questions regarding the efficacy of medications remain, despite general endorsement by clinical practice guidelines of selective serotonin reuptake inhibitors (SSRIs) as first-line agents in treating PTSD. This paper reviews evidence from randomized controlled trials (RCTs) for the efficacy of acute and long-term pharmacotherapy for PTSD, including the treatment of refractory PTSD. In addition, we conducted a systematic meta-analysis to compare the efficacy of different medications in treating PTSD. The effects of methodological study features (including year of publication, duration, number of centres) and sample characteristics (proportion of combat veterans, gender composition) were also tested. The largest body of evidence for short- and long-term efficacy of medication currently exists for SSRIs, with promising initial findings for the selective noradrenergic reuptake inhibitor venlafaxine and the atypical antipsychotic risperidone. Treatment effect was predicted by number of centres and recency of the study, with little evidence that sample characteristics predicted response. Evidence for the effectiveness of benzodiazepines is lacking, despite their continued use in clinical practice. Finally, the α1 antagonist prazosin and the atypical antipsychotics show some efficacy in treatment-resistant PTSD. Adequately powered trials that are designed in accordance with best-practice guidelines are required to provide conclusive evidence of clinically relevant differences in efficacy between agents in treating PTSD, and to help estimate clinical and methodological predictors of treatment response.

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  • Venlafaxine's effect on noradrenaline reuptake is dose-dependent, starting at doses around 225 mg daily; at lower daily doses it acts on serotonin reuptake only, like a common SSRI.

    “Venlafaxine’s effect on noradrenaline reuptake is dose-dependent, starting on doses of around 225 mg daily. When the daily dose is lower, it acts on serotonin reuptake only, like a common SSRI [36, 37].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [36]

    The Other medications section identifies venlafaxine as an SNRI, and the Conclusion says studies of depression provide evidence that its efficacy is dose-dependent (page numbers unavailable). Neither passage says noradrenaline reuptake begins around 225 mg/day or that lower doses affect serotonin reuptake only; the reported dose dependence concerns efficacy, not reuptake mechanism. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • A meta-analysis from 2012 found a larger effect of venlafaxine on the Clinician-Administered PTSD Scale (CAPS).

    “Similarly, a meta-analysis from 2012 found a larger effect of venlafaxine on the Clinician-Administered PTSD Scale (CAPS) [36].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [36]

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2 of the 80 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. van der Kolk BA, Dreyfuss D, Michaels M, Shera D, et al. (1994). Fluoxetine in posttraumatic stress disorder. Journal of Clinical Psychiatry 55, 517-522.

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Authors
Ipser, J. C., & Stein, D. J.
Affiliations
University of Cape Town (ZA)
Corresponding author
Ipser, Jonathan C.
ORCID
Venue
The International Journal of Neuropsychopharmacology
Publisher
Oxford University Press (OUP)
Published
2011-07-29
Volume
15
Issue
06
Pages
825-840
ISSN
  • 1461-1457 (ISSN-L)
  • 1469-5111
DOI
10.1017/s1461145711001209
OpenAlex
W2102454290
Cited by
216
References
80
Citations by year
2026: 12 · 2025: 12 · 2024: 16 · 2023: 8 · 2022: 10 · 2021: 19 · 2020: 6 · 2019: 14 · 2018: 19 · 2017: 17 · 2016: 14 · 2015: 25 · 2014: 22 · 2013: 15 · 2012: 6
FWCI
2.11
Type
journal article
Language
en
Open access
Locations
  • The International Journal of Neuropsychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Funders
AstraZeneca
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
post-traumatic stress disorder, pharmacotherapy, selective serotonin reuptake inhibitors, venlafaxine, risperidone, prazosin, benzodiazepines, treatment-resistant PTSD, combat veterans, predictors of treatment response, randomized controlled trials
MeSH terms
Antidepressive Agents, Humans, Stress Disorders, Post-Traumatic, Antipsychotic Agents, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Evidence-Based Medicine

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