Evaluation of the Efficacy of Pharmacotherapy and Psychotherapy in Treatment of Combat-Related Post-Traumatic Stress Disorder: A Meta-Analytic Review of Outcome Studies

Abstract

A meta-analysis was conducted to examine the relative effectiveness of the broad-based treatments for combat-related post-traumatic stress disorder (PTSD). The analysis includes 13 pharmacotherapy studies and 12 psychotherapy studies obtained from a PsychINFO database search and a reference search. Studies of pharmacotherapy treatment efficacy demonstrated a significantly greater decrease in reducing PTSD symptoms, t (22) = -2.74, p = 0.01, d = 0.05. A random coefficient analysis supports this finding with significance determined at p < 0.001 for the fixed effects in the models. A limited examination of depression as a frequently comorbid disorder indicated pharmacotherapy also demonstrated a significantly greater decrease than psychotherapy in depression symptoms, t (15.77) = -2.26, p = 0.04, d = 0.16. Differences between treatments are discussed as potentially reflective of assignment to treatments and assessment techniques as well as therapeutic effects.

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

“…Psychotherapy has demonstrated significant efficacy, although a meta-analysis suggested it may be less effective than pharmacotherapy in improving PTSD and comorbid depression symptoms [895]. …”

“…Antidepressants ( SSRIs & SNRIs ) : Evidence from meta-analyses [895,1060] and RCTs supports the use of the SSRI paroxetine [966-970] and the SNRI venlafaxine XR [975,989] (both Level 1) for the first-line treatment of PTSD. Data with fluoxetine are mixed, with both positive [960-962] and negative [963-965] RCTs (Level 1, conflicting).…”

Depression and Posttraumatic Stress Disorder Comorbidity

“…At this point, we know of only one behavioral therapy model specifically designed a priori (p. 106) to address PTSD-depression comorbidity. (For information on pharmcotherapies, see Friedman, 2002;Sher et al, 2012;Stewart & Wrobel, 2009). The behavioral model is described by Nixon and Nearmy (2011) and represents a combination of already existing cognitive behavioral treatment components that have received evidence-based support for depression or PTSD separately: behavioral activation for depression in early sessions, followed by exposure therapy and cognitive restructuring for PTSD in later sessions, for a total of 12 to 16 weeks per patient.…”

Evidence-based pharmacotherapy of post-traumatic stress disorder (PTSD)

“…A number of meta-analyses of medication treatment for PTSD have been conducted to date, synthesizing data from trials of individual agents (Adamou et al 2007 ;Mooney et al 2004), as well as comparing treatment efficacy across agents (Penava et al 1996 ;Stein et al 2006 ;Stewart & Wrobel, 2009 ;Van Etten & Taylor, 1998). Although the findings of these metaanalyses have in general supported the use of phar-macotherapy, and SSRIs in particular, in treating PTSD, their conclusions have been weakened by methodological shortcomings (listed in Table 2).…”