Effective PTSD Treatment: Pharmacotherapy and Psychotherapy

Introduction

Two authoritative sources were reviewed on the topic of post-traumatic stress disorder (PTSD). The first was a textbook authored by numerous experts that provided details of their clinical experiences treating PTSD alongside their knowledge of relevant empirical research, covering the full range of available treatments. The second was a literature review detailing the relative effectiveness of different selective serotonin reuptake inhibitors (SSRIs) in the treatment of PTSD. That source was more limited in scope — confined to one class of pharmacotherapy — but identified an important gap in the current empirical literature: the absence of studies examining the relative effectiveness of combined treatment modalities. It also concluded that SSRI-based treatments are more effective over the long term than when limited to shorter-term use.

The first source reviewed was Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies (Guilford Press, 2008). The book incorporates input from a wide range of experts in the field of treating post-traumatic stress disorder. Because the work draws from multidisciplinary research and clinical experience, it provides a comprehensive reference for clinicians interested in treating PTSD, detailing the relative strengths and weaknesses of many different theoretical models and treatment interventions.

Summary of Sources

In dedicated chapters individually authored by clinical and research subject-matter experts, the book covers all traditional treatment modalities — including group therapy, psychodynamic therapy, psychosocial rehabilitation, hypnosis, couple and family therapy, pharmacotherapy, and cognitive-behavioral therapy (CBT) — as well as more recent cutting-edge approaches such as eye-movement desensitization and reprocessing (EMDR).

The second source, "Long-Term Pharmacotherapy for Post-Traumatic Stress Disorder," is a 2006 article published in the peer-reviewed journal CNS Drugs (Vol. 20, No. 6). The article details the results of a literature review of PTSD treatment through long-term pharmacological modalities. More specifically, it considered numerous studies lasting longer than 14 weeks involving both adult and pediatric subjects. It compared the empirical results of previous studies examining the effectiveness of clozapine, fluoxetine, nefazodone, paroxetine, risperidone, sertraline, and valproate.

The literature review concluded that those studies supported the long-term treatment of PTSD with selective serotonin reuptake inhibitors (SSRIs), and that this approach provides an effective means of maintaining positive responses to prior treatment, corresponds to increased quality of life, and increases positive patient response to treatment overall. SSRIs were found to account for approximately one-third of all improvement in patients receiving PTSD treatment. The review also determined that response time to pharmacological intervention was directly related to the severity of PTSD symptoms, that long-term treatment (at least 14 weeks) was significantly more effective than shorter-term treatment, and that earlier discontinuation of SSRIs was associated with both increased relapse risk and increased symptom severity.

The most important difference between the two sources is that the first addresses the full range of treatment modalities for PTSD — including pharmacotherapy — whereas the second considers only the much narrower range of pharmacological modalities using different SSRIs. Another principal difference is that the first source included narratives authored by different clinicians and experts, incorporating their anecdotal professional experiences as well as their descriptions of how their treatment approaches draw on empirical research in their respective areas of clinical expertise. As a result, that work serves as an appropriate reference for available PTSD treatment options and for the optimal combination of different approaches in specific types of cases.

Significant Differences in the Sources Reviewed

By contrast, the second source consists solely of a literature review of previous research, without any narrative contribution from clinical experts beyond the conclusions drawn in each reviewed study. More importantly, this source does not address non-pharmacological PTSD interventions, nor any combinations of multiple modalities used concurrently. The authors expressly note the apparent absence in the available literature of any studies specifically investigating the relative effectiveness of such combined forms of treatment — for example, pharmacotherapy paired with cognitive-behavioral therapy or psychodynamic therapy.

Because the value of this second source is necessarily limited to the scope of SSRI-based pharmacotherapy, perhaps its most significant contribution is precisely the identification of this gap in the research literature addressing combined forms of therapy. The authors note that this absence is particularly surprising given how routinely combined forms of therapy are used in clinical PTSD treatment.

Conclusion

Finally, because PTSD is known to result from specific types of experiences, debriefing conducted immediately following those experiences would also appear to be especially valuable. It may even provide a mechanism for reducing the incidence or severity of PTSD arising from those experiences, making early intervention through debriefing a potentially preventive as well as therapeutic tool.

Davis, L. L., Frazier, E. C., Williford, R. B., & Newell, J. M. (2006). Long-term pharmacotherapy for post-traumatic stress disorder. CNS Drugs, 20(6), 465–476.

Foa, E., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2008). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: The Guilford Press.