Pharmacotherapy for post-traumatic stress disorder
background It is only in the last few years that there has been a marked increase in the quality and quantity of placebo-controlled pharmacotherapy for post-traumatic stress disorder (PTSD). Because in clinical practice a considerable amount of medication is prescribed for patients with PTSD it is very important that those administering the treatment should be acquainted with the scientific literature on the subject.
aim To review the literature on double-blind placebo-controlled studies relating to pharma-cotherapy for PTSD.
method Medline was searched for the relevant literature published up to 1st June 2003, using as key words 'post traumatic stress disorder' or 'ptsd', together with 'pharmacotherapy' or 'medication'. results The search revealed 24 placebo-controlled studies involving a total of 2035 patients. It is difficult to draw comparisons between the studies mainly because of differences in medication, measurement-scales and populations. The drugs studied most frequently were antidepressants, and of these drugs the selective serotonine reuptake inhibitors were the ones investigated the most extensively. In one comprehensive study paroxetine proved much more successful than placebos for the treatment of all three symptom clusters of ptsd. Amitriptyline, imipramine an phenelzine (in smaller studies) and fluoxetine and sertraline (in larger studies) were found to be significantly superior to placebos for the treatment of one or more PTSD symptoms. Mirtazapine and prazosine seem to be effective, but the results were obtained from samples that were too small. There is some evidence that Vietnam veterans with chronic PTSD have a lower response than other patients to medication. conclusion A number of antidepressants are significantly more effective than placebos for the treatment of one or more PTSD symptom clusters. Other types of medication have not been investigated sufficiently in placebo-controlled studies. Neurobiological research and open treatment studies may provide useful information about the best form of treatment for the individual patient.