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Early pharmacotherapy may not prevent PTSD, acute stress disorder

Early pharmacotherapies were not significantly effective in preventing post-traumatic stress disorder or acute stress disorder, according to findings from a meta-analysis in The Lancet Psychiatry.

“Based on recent advances in cognitive neuroscience, pharmacological interventions have been proposed as a promising new option in the prevention of PTSD,” study researcher Marit Sijbrandij, PhD, of VU University Amsterdam, and colleagues wrote. “Pharmacological interventions might be the most effective if offered immediately after the traumatic event, since cognitive neuroscience studies suggest a 6-[hour] window of time after a traumatic event when fear memories might be disrupted before they are consolidated.”

To determine efficacy of pharmacotherapies for the prevention of PTSD and acute stress disorder, Sijbrandij and colleagues analyzed 15 studies with a combined cohort of 1,765 participants. Eight studies reported only on PTSD incidence, six studies reported on PTSD and acute stress disorder incidence and one study reported only on acute stress disorder.

Overall, the effect of all pharmacotherapies was not statistically significant (g = 0.32; 95% CI, –0.49 to – 0.16) and had low heterogeneity (95% CI, 0-49) compared with controls.

Pharmacotherapy was more effective for PTSD (g = – 0.42; 95% CI, – 0.57 to – 0.29) vs. ASD (g = 0.07; 95% CI, – 0.25-0.39).

Hydrocortisone had a significant effect on the prevention of PTSD symptoms (g = 0.73; 95% CI, –1.16 to – 0.29) and was significantly more effective than beta blockers (g = – 0.1; 95% CI, – 0.37-0.18).

“We found a small effect of early pharmacotherapy in preventing PTSD or [acute stress disorder]. On average, 11 trauma survivors needed to be treated to prevent one case of PTSD or [acute stress disorder],” Sijbrandij and colleagues wrote. “Importantly, our meta-analysis showed a large effect of hydrocortisone, and about seven individuals needed to be given hydrocortisone when aiming to prevent one PTSD case. For future research, larger [randomized controlled trials] in various trauma samples, taking into account acceptability, side effects, the timing of administration, and cost-effectiveness need to be done to determine whether hydrocortisone will have a role in the prevention of PTSD.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.