Pharmacotherapy for posttraumatic stress disorder (PTSD)
Citation: Williams T, Phillips NJ, Stein DJ, et al. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2022;(3):CD002795.
Language: Abstract available in EN / ES / FA. Plain language summary available in EN / ES / FA / ZH. Full text available in EN.
Free to view: No.
Funding sources: South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa.
What is this? Posttraumatic stress disorder (PTSD) is a debilitating mental condition that can be caused by experiencing a traumatic event. Pharmacotherapy might be used as part of the efforts to treat it.
In this updated Cochrane review, the authors searched for randomized trials of pharmacotherapy for adults with PTSD. They did not restrict their searches by date or language of publication and did the most recent search in November 2020. They included a total of 66 trials (7442 participants) that had tested a variety of drugs. They also identified 1 additional ongoing trial and 18 trials which are awaiting classification.
What works: Selective serotonin reuptake inhibitors (SSRIs) improved PTSD symptoms in 58% of participants compared with 35% of participants receiving a placebo (8 trials, 1078 participants, moderate certainty evidence), but there were more withdrawals due to adverse events in the SSRI groups than the placebo groups, although the overall withdrawal rate for the SSRI groups was low (9%).
Single trials suggested that the noradrenergic and specific serotonergic antidepressant mirtazapine (26 participants) and the tricyclic antidepressant amitriptyline (40 participants) improved PTSD symptoms compared to a placebo (low certainty evidence).
What doesn’t work: Nothing noted.
What is uncertain: The effects of antipsychotics compared to a placebo are uncertain.
Implications: The authors of the review concluded that medication treatments can be effective in PTSD, increasing treatment response and reducing symptoms, and should be considered as part of its treatment.
Other considerations: The authors of the review did not discuss their findings in the context of issues relating to health equity.
This summary was prepared by Catherine Haynes and finalized by Mike Clarke.
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