Selective serotonin reuptake inhibitors are effective in reducing symptoms of post-traumatic stress disorder (PTSD), according to a large meta-analysis published in Issue 1 (2006) of the Cochrane Database of Systematic Reviews.

Drug therapy for PTSD is currently in early stages of data collection, and so it is not yet known if other types of drugs might work as well.

“Although there is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other, the greatest number of trials showing efficacy to date, as well as the largest, have been with selective serotonin reuptake inhibitors,” concluded the review authors, led by Dan Stein, MD, of the University of Cape Town in South Africa.

The review evaluated 35 randomized controlled trials involving 4,597 patients with the disorder who were treated with either placebo or a selective serotonin reuptake inhibitor. The studies were all short-term, lasting 14 weeks or less.
Of those taking the medication, 59 percent responded well compared with 38 percent of those on placebo. The most effective individual drugs tested were paroxetine and, to a lesser extent, sertraline.

“In some clinical settings it is not uncommon to combine medication and psychotherapy,” Stein said. “Most studies tend to focus on either medication or psychotherapy, although there are now some data coming out showing that psychotherapy can be useful in further decreasing symptoms after a trial of medication.”

According to Anthony T. Ng, MD, chair of the Committee on Psychiatric Dimensions of Disaster for the American Psychiatric Association, medication should not be a substitute for the support afforded by visits to a physician.
“Some patients with PTSD have trouble forming relationships,” he said. “While ideally, patients with PTSD should be monitored regularly, the very fact of coming in even once a month or once every two months for some for medication checks may help form connections so they can develop the support they need.” Ng added, “Depending on the patient’s symptoms, different types or combinations of medications may have better effects. We may find some work better than other depending on the source of the PTSD.”

Ultimately, Ng says, the mix of medication and psychotherapy can also be driven by the patient. “If the patient says they don’t have time to come in and see me and they just want a pill versus going through psychotherapy, it may not be the best treatment for the patient. We need to educate patients about their treatment options, including medication, psychotherapy and the use of psychosocial support.”
“Given the prevalence and costs of PTSD, there is a need for further controlled clinical trials in the treatment of this disorder,” the review authors concluded. “Questions for further research also include the precise effects of medication on quality of life measures, appropriate dose and duration of medication, and determining factors which predict response to medication.”