Patient and Clinical Factors Associated With Response to Medications for Posttraumatic Stress Disorder

Abstract

Objective: Fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine have previously shown efficacy for posttraumatic stress disorder (PTSD) in randomized clinical trials. Two prior studies using Department of Veterans Affairs (VA) medical records data show these medications are also effective in routine practice. Using an expanded retrospective cohort, we assessed the possibility of differential patterns of response based on patient and clinical factors. Methods: We identified 6,839 VA outpatients with clinical diagnoses of PTSD between October 1999 and September 2019 who initiated one of the medications and met pre-specified criteria for treatment duration and dose, combined with baseline and endpoint PTSD checklist (PCL) measurements. We compared 12-week changes in PCL score within clinical subgroups defined by sex, race and ethnicity, and military exposures, as well as comorbidities. Comorbidities were identified using International Classification of Diseases diagnostic codes and grouped according to major diagnostic classifications in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (eg, Psychotic Disorders, Depressive Disorders). We used a propensity score weighting approach to balance covariates among medication arms within each clinical subgroup. In our exploratory analyses using unweighted data for the overall cohort, we built penalized logistic regression models to identify covariates that predicted meaningful improvement. Results: There were no significant differences between medications in our weighted subgroup analyses. In unweighted exploratory analyses, higher baseline PCL scores and concurrent receipt of evidence-based psychotherapy predicted meaningful improvement, while high levels of disability predicted not realizing meaningful improvement. Conclusions: In the largest real-world study of medications for PTSD to date, we did not observe a pattern of differential response among clinical subgroups. All patients taking medications for PTSD, especially those with the highest levels of disability, should consider combined treatment with evidence-based psychotherapy.

Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer

“…PCL‐5 change scores of 15–18 are indicative of reliable change 24 . A difference score of 5.7–10.2 (midpoint of 7.9) is indicative of a minimal clinically important difference (MCID) 32 and a decrease of 15 points or more indicates clinically meaningful improvement 33 . The PCL‐5 has good psychometric properties, 31 including with Iranian samples 34 .…”

“…24 A difference score of 5.7-10.2 (midpoint of 7.9) is indicative of a minimal clinically important difference (MCID) 32 and a decrease of 15 points or more indicates clinically meaningful improvement. 33 The PCL-5 has good psychometric properties, 31 including with Iranian samples. 34 In the current study internal consistency was good (Cronbach's alpha = 0.92).…”

“…We assessed acceptability of intervention by measuring loss to follow-up and the number of WET sessions attended by participants in the WET arm of the trial. For PTSD symptoms, we used the PCL-5 to assess reliable change (≥18 24 ), MCID (>10.2 32 ), and clinically significant change (decrease of ≥15 points 33 ). For the secondary analyses, we used a series of 2 (group; WET vs. control) x 3 (time; baseline, post-intervention, follow-up) mixed analysis of variances to quantify group differences in QoL, number of specific memories retrieved, and illness perceptions.…”

Association between post-traumatic stress disorder severity and death by suicide in US military veterans: retrospective cohort study

“…24 The mean baseline score for VA patients starting PTSD treatment in this PCL dataset is approximately 50. 25 Based on these thresholds, we created exposure groups using four PCL score ranges: minimal (0-18), low (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), moderate (31-49) and high (≥50).…”