Venlafaxine offers enhanced benefit for PTSD symptoms vs. other treatments

Venlafaxine may be superior vs. other agents to achieve acute-phase remission for DSM-5 PTSD, according to study results published in Journal of Clinical Psychiatry.

“Randomized controlled trials (RCTs) show that effective treatments for PTSD include both pharmacologic and psychotherapeutic approaches,” Brian Shiner, MD, MPH, of the National Center for PTSD in Vermont, and colleagues wrote. “Several individual medications have shown efficacy as PTSD treatments in placebo-controlled RCTs. Because there are limited data comparing medications that are individually superior to placebo to one another in a single population, one prior VA study used electronic medical record data from 2008 to 2013 to compare the real-world clinical effectiveness of [five] efficacious medications.”

Although results of this prior study suggested no symptom reduction differences between fluoxetine, sertraline, paroxetine, topiramate and venlafaxine, the study contained several weaknesses: limited standardization of treatment duration, use of an outdated measure of patient-reported PTSD outcomes, lack of a functional outcome and inability to account for prior treatment receipt.

In the current study, Shiner and colleagues attempted to address these weaknesses. They identified 834 VA outpatients who had clinical diagnoses of PTSD according to DSM-5 criteria. Further participant inclusion criteria were initiation of one of the aforementioned medications and meeting prescribed criteria for treatment duration and dose, combined with baseline and endpoint measurements from the DSM-5 PTSD Checklist (PCL-5). The investigators compared 12-week acute-phase changes in PCL-5 score and PTSD symptom remission among patients who received the selected medications. They also evaluated acute psychiatric service use in the subsequent continuation phase of 6 months.

Results showed an acute phase mean patient improvement of 6.8 to 10.1 points on the PCL-5, and 0% to 10.9% of patients achieved symptom remission. Patients on venlafaxine achieved significantly higher rates of remission compared with those on fluoxetine, paroxetine, sertraline or topiramate. Shiner and colleagues observed no differences in acute psychiatric care use between medications in the continuation phase. Moreover, acute psychiatric service use was lower among those who continued their medication.

“Our study lacks adequate sample size to adequately address issues regarding either specific medication effects on specific symptoms or patient characteristics that predict response with a particular medication,” the researchers wrote. “These are both fertile areas for future research.”