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Cited by 418Posttraumatic Stress Disorder ResearchMigration, Health and TraumaSleep and related disorders

Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis

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Hoskins, Mathew, Pearce, Jennifer, Bethell, Andrew, Dankova, Liliya, Barbui, Corrado, Tol, Wietse A., van Ommeren, Mark, de Jong, Joop +3 more·2015·British Journal of Psychiatry
DOI 10.1192/bjp.bp.114.148551
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Abstract

Background: Pharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy. Aims: To determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability. Method: A systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included. Results: Selective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine. Conclusions: Some drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

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Crossref · 10.1192/bjp.bp.114.148551

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  • Only sertraline and paroxetine are currently approved pharmacotherapies for PTSD, and both have high relapse rates.

    “Only two pharmacotherapies are currently approved for PTSD-sertraline and paroxetine-and both have high relapse rates [100]”

    From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [100]

    The discussion of individual drugs (section labelled SKB627 E; page unavailable) treats sertraline and paroxetine as pharmacotherapies for PTSD. The paper does not establish that they are the only approved drugs or report high relapse rates for both; its stated outcome measures are symptom severity and early withdrawal. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Some medications (fluoxetine, paroxetine, venlafaxine) have shown significant but small superiority over placebo (mean effect size=0.23) in PTSD treatment for adults.

    “Although some medications (eg, fluoxetine, paroxetine and venlafaxine) have shown a significant but small superiority over placebo (mean effect size=0.23) in PTSD treatment for adults,12”

    From Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: Study protocol for a systematic review and network meta-analysis (2018) · cites this paper as [12]

    The Results and Efficacy of pharmacotherapy sections report statistically significant, small benefits over placebo for fluoxetine, paroxetine and venlafaxine. However, the effect size of 0.23 is for SSRIs pooled as a class, not for those three medications together; venlafaxine is not an SSRI. The Description of studies reports participant ages of 18–82 years. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The most recent meta-analysis on mixed groups of PTSD patients found evidence for the effect of venlafaxine to be superior to that of sertraline.

    “The most recent meta-analysis on mixed groups of PTSD patients found the evidence for the effect of venlafaxine to be superior to that of sertraline [35].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [35]

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Cites

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Research works printed but not linked: 8

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR). APA, 2000.
  2. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. American Psychiatric Press, 2004.
  3. Institute of Medicine. Treatment of PTSD: An Assessment of the Evidence. National Academies Press, 2008.
  4. Wang H-H, Tan Q-R, Wang Z-Z, Wang H-N, Cheng C-G, Chen Y-C, et al. A randomised controlled study on prevention of posttraumatic stress disorder. J Clin Psychol Med 2009; 1: 1-3.
  5. Kaplan Z, Amir M, Swartz M, Levine J. Inositol treatment of posttraumatic stress disorder. Anxiety 1996; 2: 51-2.
  6. Van der Kolk BA, Dreyfuss D, Michaels M, Shera D, Berkowitz R, Fisler R. Fluoxetine treatment in posttraumatic stress disorder. J Clin Psychiatry 1994; 55: 517-22.
  7. Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 2003; 159: 1777-9.
  8. Davidson JRT, Connor KM, Hertzberg MA, Weisler RH, Wilson WH, Payne VM. Maintenance therapy with fluoxetine in posttraumatic stress disorder: a placebo-controlled discontinuation study. J Clin Psychopharmacol 2005; 25: 166-9

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Authors
Hoskins, M., Pearce, J., Bethell, A., Dankova, L., Barbui, C., Tol, W. A., van Ommeren, M., de Jong, J., Seedat, S., Chen, H., & Bisson, J. I.
Affiliations
University of Verona (IT)
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2015-02
Volume
206
Issue
2
Pages
93-100
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.114.148551
OpenAlex
W2150901658
Cited by
418
References
88
Citations by year
2026: 25 · 2025: 31 · 2024: 30 · 2023: 45 · 2022: 41 · 2021: 44 · 2020: 44 · 2019: 36 · 2018: 35 · 2017: 37 · 2016: 31 · 2015: 10 · 2014: 2 · 2013: 1 · 2012: 3
FWCI
5.41
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 1066 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • World Health Organization
  • National Center for PTSD, U.S. Department of Veterans Affairs
  • National Center for Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
post-traumatic stress disorder, pharmacotherapy, selective serotonin reuptake inhibitors, fluoxetine, paroxetine, venlafaxine, placebo comparison, treatment efficacy, treatment acceptability, PTSD symptom reduction
MeSH terms
Humans, Stress Disorders, Post-Traumatic, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors

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