A controlled trial of paroxetine for chronic PTSD, dissociation, and interpersonal problems in mostly minority adults

Abstract

This study evaluated the efficacy of paroxetine for symptoms and associated features of chronic posttraumatic stress disorder (PTSD), interpersonal problems, and dissociative symptoms in an urban population of mostly minority adults. Adult outpatients with a primary DSM-IV diagnosis of chronic PTSD received 1 week of single-blind placebo (N = 70). Those not rated as significantly improved were then randomly assigned to placebo (N = 27) or paroxetine (N = 25) for 10 weeks, with a flexible dosage design (maximum 60 mg by week 7). Significantly more patients treated with paroxetine were rated as responders (14/21, 66.7%) on the Clinical Global Impression-Improvement Scale (CGI-I) compared to patients treated with placebo (6/22, 27.3%). Mixed effects models showed greater reductions on the Clinician-Administered PTSD Scale (CAPS) total score (primary plus associated features of PTSD) in the paroxetine versus placebo groups. Paroxetine was also superior to placebo on reduction of dissociative symptoms [Dissociative Experiences Scale (DES) score] and reduction in self-reported interpersonal problems [Inventory of Interpersonal Problems (IIP) score]. In a 12-week maintenance phase, paroxetine response continued to improve, but placebo response did not. Paroxetine was well tolerated and superior to placebo in ameliorating the symptoms of chronic PTSD, associated features of PTSD, dissociative symptoms, and interpersonal problems in the first trial conducted primarily in minority adults.

Post-traumatic stress disorder: new directions in pharmacotherapy

“…In a later study involving 70 people with chronic PTSD, Marshall et al (2007) found significantly different response rates of 67% for paroxetine v. 27% for placebo after 10 weeks. Exposure therapy (a form of CBT) plus paroxetine has been found superior in producing remission compared with exposure therapy plus placebo (Schneier 2012).…”

Pharmacotherapy of Post-Traumatic Stress Disorder

“…As with sertraline, the beneficial effects of paroxetine were noticeable at week 4 (Tucker et al 2001) in one trial, and both trials showed evidence of significant improvement in measures of social and occupational function at endpoint. With the majority of previously published trials using primarily Caucasian populations, a more recent RCT by Marshall et al (2007) was able to demonstrate that the positive effects of paroxetine (up to 60 mg) extended to a sample with a high proportion of ethnic minorities (75%). Further, benefits of the medication were seen not only for core PTSD symptoms but also for dissociative symptoms and interpersonal problems, psychopathology that often accompanies this illness.…”

PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

“…In 2010, the US Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline (CPG) for Management of PTSD established sertraline, paroxetine, and the selective serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine as the first line pharmacological treatments for PTSD 36. These recommendations were established based on results from numerous randomized controlled trials (RCT) using SSRI/SNRIs, including sertraline,37,38 paroxetine,39 and venlafaxine 40. Although the evidence supports the use of SSRI/SNRIs for symptom reduction in PTSD, the overall effect sizes are modest 41,42.…”