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PTSD medications equally effective in clinical practice

In clinical practice, evidence-based medications — fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine — were equally effective treatments for PTSD, according to data published in the Journal of Clinical Psychiatry.

Although about 50% of patients showed improvement of 5 points or more on the PTSD Checklist, less than 20% achieved loss of PTSD diagnosis, the results showed.

“Given advancements in data, including increasing availability of patient reported outcome data in the electronic medical record and the need for large numbers to support research on more personalized medicine, observational studies are a logical extension of comparative effectiveness research on psychotropic medications for PTSD,” Brian Shiner, MD, MPH, of the White River Junction VA Medical Center, Vermont, and assistant professor of psychiatry at Dartmouth Geisel School of Medicine, and colleagues wrote.

In this retrospective comparative effectiveness study, Shiner and colleagues examined the effectiveness of fluoxetine, paroxetine, sertraline, topiramate and venlafaxine in clinical practice among patients with PTSD.

Using EMR data, researchers identified 2,931 Veterans Affairs outpatients starting treatment for PTSD between 2004 and 2013 who received one of the five medications, along with baseline and endpoint PTSD Checklist measurements. Using weighted regression analyses, they compared participants’ changes on total PTSD Checklist score, symptom cluster scores, sleep items, reliable improvement and loss of PTSD diagnosis. Exploratory analysis was also performed to examine whether any characteristics or service use variables predicted loss of PTSD diagnosis.

All five medications for PTSD demonstrated a significant effect on symptoms in clinical practice, according to the study results. Over about 6 months of treatment, the mean improvement in PTSD symptom scores ranged from 5 to 6.3 points on the PTSD Checklist, indicating modest improvements. Furthermore, between 41.9% and 52.9% of participants achieved a reliable improvement of 5 points or more on the Checklist and between 13.6% and 20.4% achieved loss of PTSD diagnosis. The researchers observed no differences between medications.

Results from the exploratory analysis showed that simultaneous treatment with evidence-based psychotherapy — including cognitive processing therapy and prolonged exposure — was the only significant predictor of loss of PTSD diagnosis.

“While we found that all of the medication treatments for PTSD that we studied were effective in clinical practice, their effect seemed reduced compared to that seen in the clinical trials,” Shiner and colleagues wrote. “Although effective, our data suggest that patients choosing medication treatment for PTSD should consider concurrent treatment with [evidence-based practices] for PTSD in order to maximize their chances of meaningful improvement.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.