Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches

Hoskins, Mathew D., Bridges, Jack, Sinnerton, Robert, Nakamura, Anna, Underwood, Jack F. G. ORCID: https://orcid.org/0000-0003-1731-6039, Slater, Alan, Lee, Matthew R. D., Clarke, Liam, Lewis, Catrin ORCID: https://orcid.org/0000-0002-3818-9377, Roberts, Neil P. and Bisson, Jonathan I. ORCID: https://orcid.org/0000-0001-5170-1243 2021. Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches. European Journal of Psychotraumatology 12 (1) , 1802920. 10.1080/20008198.2020.1802920

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Abstract

Background: Pharmacological approaches are widely used for post-traumatic stress disorder (PTSD) despite uncertainty over efficacy. Objectives: To determine the efficacy of all pharmacological approaches, including monotherapy, augmentation and head-to-head approaches (drug versus drug, drug versus psychotherapy), in reducing PTSD symptom severity. Method: A systematic review and meta-analysis of randomised controlled trials were undertaken; 115 studies were included. Results: Selective serotonin reuptake inhibitors (SSRIs) were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.28, 95% CI −0.39 to −0.17). For individual monotherapy agents compared to placebo in two or more studies, we found small statistically significant evidence for the antidepressants fluoxetine, paroxetine, sertraline, venlafaxine and the antipsychotic quetiapine. For pharmacological augmentation, we found small statistically significant evidence for prazosin and risperidone. Conclusions: Some medications have a small positive effect on reducing PTSD symptom severity and can be considered as potential monotherapy treatments; these include fluoxetine, paroxetine, sertraline, venlafaxine and quetiapine. Two medications, prazosin and risperidone, also have a small positive effect when used to augment pharmacological monotherapy. There was no evidence of superiority for one intervention over another in the small number of head-to-head comparison studies.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/)
Publisher:	Taylor && Francis
ISSN:	2000-8198
Date of First Compliant Deposit:	23 February 2021
Date of Acceptance:	16 July 2020
Last Modified:	30 May 2024 01:08
URI:	https://orca.cardiff.ac.uk/id/eprint/138703

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