For PTSD, prolonged exposure bests sertraline

  • Zoellner LA & al.
  • Am J Psychiatry
  • 19 Oct 2018

  • curated by Jim Kling
  • Clinical Essentials
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  • Patients with posttraumatic stress disorder (PTSD) improved with either sertraline (Zoloft) or prolonged exposure therapy in this doubly randomized preference trial. 
  • Prolonged exposure achieved better results by some measures.
  • Patients had greater benefits when receiving their preferred treatment.

Why this matters

  • This is the largest randomized trial directly comparing cognitive behavioral therapy with a selective serotonin reuptake inhibitor in people with PTSD.

Study design

  • Preference trial (PTSD, n=200).
  • Randomization:
    • Choice of treatment, n=97.
    • No choice of treatment, n=103.
  • Re-randomization:
    • Choice of treatment (prolonged exposure, n=61; sertraline, n=36).
    • No choice of treatment (prolonged exposure, n=55; sertraline, n=48).
  • Funding: National Institute of Mental Health; others.

Key results

  • Prolonged exposure (psychotherapy sessions, 10 weekly 90-120-minute sessions) was preferred over sertraline treatment:
    • 61% vs 39%; number needed to treat (NNT), 4.5 (P<.01>
  • Symptoms declined at a slower rate with sertraline (group differences were moderate); declines over time for the whole cohort were significant:
    • PTSD severity: P<.001>
    • depression: P=.02;
    • state anxiety: P<.001 and>
    • Sheehan Disability Scale: P=.006.
  • Prolonged exposure group vs sertraline group was more likely to have loss of PTSD diagnosis (NNT, 7.0) and responder status (NNT, 5.7).
  • Patients who received their preferred treatment were more likely to lose their PTSD diagnosis (NNT, 3.4; P<.001>


  •  No placebo group.

Coauthored with Chitra Ravi, MPharm 

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