Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder

Merz, Jasmin; Schwarzer, Guido; Gerger, Heike

doi:10.1001/jamapsychiatry.2019.0951

Cited by 128 publications

(70 citation statements)

References 86 publications

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“…Overall, among enrolled participants, all of whom previously failed to tolerate or respond to other medications and/or therapies, there was a 7.6% dropout rate in the treatment period across the six MDMA phase 2 studies. This falls close to the lower range cited in the literature for other pharmacotherapies and trauma-focused psychotherapies (0-79%) (Imel et al 2013;Lee et al 2016;Merz et al 2019) and below an average reported dropout rate of 29% (Lee et al 2016). Additionally, 94% of participants reported the opinion that more MDMA sessions would be helpful.…”

Section: Discussionsupporting

confidence: 75%

“…Pharmacological treatments for PTSD typically require daily administration of medications, and symptoms often return when patients discontinue their medications (Batelaan et al 2017). Psychotherapies for PTSD, compared to pharmacotherapies, have greater effects with more enduring benefits (Kline et al 2018;Lee et al 2016;Merz et al 2019) and typically have lower dropout rates. This is particularly true of trauma-focused therapies, which are considered first-line treatment for PTSD, that require participants to engage with trauma-related thoughts, feelings, and responses (Lee et al 2016;Steenkamp et al 2015).…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials

et al. 2020

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Rationale Posttraumatic stress disorder (PTSD) is a chronic condition that has wide-ranging negative effects on an individual's health and interpersonal relationships. Treatments with long-term benefits are needed to promote the safety and well-being of those suffering from PTSD. Objectives To examine long-term change in PTSD symptoms and additional benefits/harms after 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for treatment of PTSD. Methods Participants received two to three active doses of MDMA (75-125 mg) during blinded or open-label psychotherapy sessions with additional non-drug therapy sessions. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM IV (CAPS-IV) at baseline, 1 to 2 months after the last active MDMA session (treatment exit), and at least 12 months post final MDMA session (LTFU). A mixed-effect repeated-measures (MMRM) analysis assessed changes in CAPS-IV total severity scores. The number of participants who met PTSD diagnostic criteria was summarized at each time point. Participants completed a long-term follow-up questionnaire. Results There was a significant reduction in CAPS-IV total severity scores from baseline to treatment exit (LS mean (SE) = − 44.8 (2.82), p < .0001), with a Cohen's d effect size of 1.58 (95% CI = 1.24, 1.91). CAPS-IV scores continued to decrease from treatment exit to LTFU (LS mean (SE) = − 5.2 (2.29), p < .05), with a Cohen's d effect size of 0.23 (95% CI = 0.04, 0.43). The number of participants who no longer met PTSD criteria increased from treatment exit (56.0%) to LTFU (67.0%). The majority of participants reported benefits, including improved relationships and well-being, and a minority reported harms from study participation. Conclusions PTSD symptoms were reduced 1 to 2 months after MDMA-assisted psychotherapy, and symptom improvement continued at least 12 months post-treatment. Phase 3 trials are investigating this novel treatment approach in a larger sample of participants with chronic PTSD.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials

et al. 2020

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“…These findings partly concur with Merz and colleagues, who recently showed that psychotherapeutic treatments are superior to pharmacological treatments for adults with PTSD at last follow-up but not at end of treatment, reaffirming the view that pharmacological therapy should not be used as first-line treatment for PTSD [145]. Our findings endorse this view and extend the relevance of international guideline recommendations that favour using TF-CBT and EMDR as first-line treatment for PTSD symptoms to those with histories of complex trauma.…”

Section: Plos Medicinesupporting

confidence: 82%

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

et al. 2020

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Background Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events.

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“…Current guidelines for PTSD suggest psychotherapy as first-line treatment over pharmacological monotherapies, namely the SSRIs sertraline and paroxetine, the only two Federal Drug Administration (FDA)-approved medications for PTSD [52]. The effect size for both exposure therapy and CBT, two popular psychotherapeutic options, was about 8.0 when compared to waitlist or supportive counseling [53].…”

Section: Ptsdmentioning

confidence: 99%

A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses

Chi¹,

Gold²

2020

Journal of the Neurological Sciences

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Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder

Cited by 128 publications

References 86 publications

RETRACTED ARTICLE: Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials

RETRACTED ARTICLE: Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses

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