Comparison between paroxetine and behaviour therapy in patients with posttraumatic stress disorder (PTSD): A pilot study

Abstract

Antidepressants and cognitive-behavioural therapy (CBT) have been reported to decrease severity of psychopathology in PTSD-patients. To date, no study has been carried out which compares psychopharmacolo-gical and psychotherapeutic treatments. In a randomized pilot study, PTSD-patients were treated either with paroxetine or CBT. Diagnoses were made by structured clinical interviews (ADIS, CAPS). The duration of treatment was 3 months; the paroxetine dosage was 10-50 mg; exposure and cognitive restructuring were the main elements in cognitive-behavioural therapy. Twenty-one patients were included. Drop-outs in both groups occurred within the first 2 weeks. Paroxetine and CBT significantly decreased PTSD-symptoms (CAPS) as well as concurrent depression (MADRS) after 3 months treatment. At 6 month follow-up, symptoms of PTSD had slightly increased in the paroxetine group and further decreased in the cognitive-behavioural therapy group. (Int J Psych Clin Pract 2004; 8: 19-23).

Prolonged exposure, paroxetine and the combination in the treatment of PTSD following a motor vehicle accident. A randomized clinical trial – The “TRAKT” study

“…The clinically meaningful, large within-group effect sizes for the SCID, PDS and BDI are also in line with other studies, including the meta-analysis of Powers, Halpern, Ferenschak, Gillihan, and Foa (2010), who observed PE to be unequivocally superior to a wait-list or placebo but not superior to other active treatments (only psychological treatments were compared in the Powers' meta-analysis). Results of very few available head to head comparisons of PE and SSRI for PTSD show similar (Shalev et al 2012, e significantly lower remission rate in pharmacotherapy group than in CBT) pattern of results or are only partially supported by our results (Frommberger et al, 2004, no difference in clinical assessment of PTSD, better self-rated outcome after PE than paroxetine).…”

“…First, there is a discrepancy among studies on psychotherapy or pharmacotherapy alone e and few studies compare them (NICE, 2005; see also Benedek, Friedman, Zatzick, & Ursano, 2009;Institute of Medicine, 2008;Frommberger et al, 2004). The reviews (Forbes et al 2010;Hetrick, Purcell, Garner, & Parslow, 2010) stress that even fewer trials (e.g., Otto et al, 2003;Rothbaum et al 2006;Schneier et al 2012) compared the combination of psycho-and pharmacotherapy to monotherapy.…”

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

“…Based on the study selection criteria noted earlier, 21 anxiety studies [8,11,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were included with 625 patients randomized to receive medication and 641 patients randomized to receive therapy. For depression studies, 21 studies were included [7,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] with 1,095 patients randomized to medication and 932 patients randomized to therapy.…”

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…There have been very few direct comparisons of the efficacy of psychological and pharmacological treatments, in either acute or long-term treatment of patients with post-traumatic stress disorder. A small unblinded 12-week comparison of paroxetine and trauma-focused CBT [III] (Frommberger et al, 2004) suggested that CBT may have certain advantages, in reducing the severity of post-traumatic and depressive symptoms. A systematic review of four studies of the combination of pharmacological with psychological treatments could find insufficient evidence to draw conclusions about the relative efficacy of combination treatment compared to monotherapy [I (M)] (Hetrick et al, 2010), although a more recent randomised placebo-controlled trial found evidence that paroxetine could enhance the effectiveness of prolonged (10 sessions) exposure therapy [I (PCT)] (Schneier et al, 2012).…”