PTSD: trauma-focused psychotherapy, medication, or both?

  • Rauch SAM & al.
  • JAMA Psychiatry
  • 5 Dec 2018

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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  • Patients with posttraumatic stress disorder (PTSD) who received 24 weeks of treatment with prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, or sertraline plus enhanced medication management all had marked reductions in PTSD symptoms.
  • None of the 3 approaches was better at reducing PTSD severity than the others.

Why this matters

  • National guidelines recommend trauma-focused psychotherapy over medication for the treatment of PTSD, but this is the first head-to-head comparison of the 2 treatment approaches vs a combination of the 2.

Study design

  • Head-to-head randomized clinical trial enrolled 207 service members/veterans of the Iraq and/or Afghanistan wars with combat-related PTSD.
  • Treatment groups: sertraline hydrochloride (n=71), placebo+prolonged exposure therapy (PE; n=67), sertraline+PE (n=69).
  • Funding: US Department of Defense; NIH.

Key results

  • At 24 weeks, all treatment groups showed significant reductions in the severity of PTSD symptoms (measured by Clinicians-Administered PTSD Scale [unadjusted CAPS]; all P<.001 style="list-style-type:circle;">
  • sertraline+enhanced medication management (33.8 points),
  • sertraline+PE (32.7 points), and
  • placebo+PE (29.4 points).
  • The primary model of longitudinally assessed CAPS scores found no significant difference between placebo+PE vs sertraline+enhanced medication (P=.05) and vs sertraline+PE (P=.16) groups.
  • Limitations

    • Findings were limited to combat veterans.

    Coauthored with Chitra Ravi, MPharm

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