Neither Psychotherapy Nor Medications Favored for PTSD

For adults with posttraumatic stress disorder (PTSD), the evidence is insufficient to determine whether trauma-focused psychotherapy or medications are more effective for symptom reduction, according to a review published in the December issue of Psychiatry Research.

Jeffrey Sonis, M.D., from the University of North Carolina at Chapel Hill, and Joan M. Cook, Ph.D., from Yale University in New Haven, Connecticut, identified trials comparing a trauma-focused psychotherapy to a selective serotonin reuptake inhibitor or serotonin/norepinephrine reuptake inhibitor, with PTSD symptom reduction as the primary outcome. The inclusion criteria were met by four trials.

In random effects meta-analysis of the two trials that were not at high risk of bias, the researchers observed no difference in PTSD symptom reduction; the confidence interval was wide, including values consistent with effects favoring psychotherapy to effects favoring medication. There was high heterogeneity, with I² = 81 percent. Substantive conclusions were not altered with inclusion of the two trials with high risk of bias.

"The bottom line is that while many researchers and clinicians believe that psychotherapy is more effective for treatment of PTSD than medications, our research shows that there is -- as of right now -- insufficient evidence from head-to-head trials to make that determination at this time," Sonis said in a statement. "Therefore, the choice of medication or psychotherapy as the initial treatment should be based on patient preferences for treatment characteristics and not on incorrect assumptions about which treatment is more effective."

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