Table 17Summary of efficacy and strength of evidence of PTSD pharmacological treatments

TreatmentN Trials (Subjects)FindingsSOE
Fluoxetine (SSRI)PTSD symptomsa4 (835)47, 6163Reduced PTSD symptoms

SMD −0.28 (95% CI −0.42 to −0.14)
Moderate
Depression symptomsb3 (771)47, 61, 62Similar reduction in depression symptoms

SMD −0.20 (95% CI −0.40 to 0.00)
Low SOE for no differencec
Paroxetine (SSRI)PTSD symptomsa2 (348)64, 65Reduced PTSD symptoms

SMD of −0.56 to −0.44 in individual studies
Both studies favored treatment (2 of 2 studies p<0.05)
Moderate
PTSD symptom remission2 (348)64, 65Greater PTSD symptom reduction

RD of 0.13 and 0.19 across 2 individual studies (1 of 2 studies p<0.05)
Moderate
Depression symptomsb2 (348)64, 65Reduced depression symptoms

SMD range −0.60 to ‑0.34 across individual studies

Both studies favored treatment (2 of 2 studies p<0.05)
Moderate
Sertraline (SSRI)PTSD symptomsa7 (1,085)6672Reduced PTSD symptoms

SMD −0.20 (95% CI −0.36 to −0.04)
Lowd
Depression symptomsb7 (1,085)6672Similar reduction in depression symptoms

SMD −0.14 (95% CI −0.33 to 0.06)
Low for no differencee
Venlafaxine (SNRI)PTSD symptomsa2 (687)69, 73Reduced PTSD symptoms

SMD −0.35 and −0.26 across two individual studies
Moderate
PTSD symptom remission2 (687)69, 73Greater PTSD symptom remission

RD of 0.12 and 0.15 across individual studies
Moderatef
Depression symptomsb2 (687)69, 73Reduced depression symptoms

Between-group mean difference of −2.6 and ‑1.6 across individual studies
Moderateg
Prazosin (alpha blocker)PTSD symptomsa3 (117)7476Reduced PTSD symptoms

SMD −0.52 (95% CI, −0.90 to −0.14)
Low
Topiramate (anticonvulsant)PTSD symptomsa3 (142)7779Reduced PTSD symptoms

SMD range of −1.85 to −0.38 across individual studies
Lowh
Olanzapine (antipsychotic)PTSD symptomsa

2 (47)80, 81

3 (62)8082
Reduced PTSD symptoms

SMD of −1.15 and −0.96 across individual studies,80, 81 both significantly favored treatment

SMD range −1.15 to 0.89 across individual studies

All studies favored treatment (2 of 3 studies p<0.05)
Low
Risperidone (antipsychotic)PTSD symptomsa4 (422)8386Reduced PTSD symptoms

SMD −0.26 (95% CI, −0.52 to −0.01)
Low

NOTE: Outcomes graded as insufficient are not included in this table. Insufficient evidence was provided for divalproex (anticonvulsant), tiagabine (anticonvulsant), citalopram (SSRI), all TCAs, buproprion (other second-generation antidepressant [SGA]), and mirtazapine (other SGA). No studies that met inclusion criteria rated as having low or medium risk of bias evaluated lamotrigine (anticonvulsant), any benzodiazepine, desvenlafaxine (SNRI), duloxetine (SNRI), nefazodone (other SGA), or trazodone (other SGA).

a

SMD from Clinician-Administered PTSD Scale and other various PTSD symptom scales.

b

SMD from the Beck Depression Inventory and other various depression symptom scales.

c

SOE changed from moderate in the prior review to low for no difference in the updated review. Only 2 of 3 studies favored treatment; one favored placebo. Imprecision, inconsistency, and effect sizes near the null prompted the change in grade.

d

SOE changed from moderate in the prior review to low in the updated review. The studies were inconsistent in whether findings favored treatment or the inactive comparator group, and findings were imprecise.

e

SOE changed from low to low for no difference in the updated review. The studies were inconsistent in whether findings favored treatment or the inactive comparator group, findings were imprecise, and most individual study estimates were close to the null.

f

SOE changed from insufficient to moderate in the updated review because of consistent evidence across two studies of adequate sample sizes.

g

SOE changed from low to moderate in the updated review because of consistent evidence across two studies of adequate sample sizes.

h

SOE changed from moderate in the prior review to low in the updated review. The findings were imprecise; only 1 of 3 individual studies found significant differences between study groups, and the sample sizes were small.

CI = confidence interval; N = number; PTSD = posttraumatic stress disorder; RD = risk difference; SGA = second-generation antidepressant; SMD = standardized mean difference; SNRI = serotonin and norepinephrine reuptake inhibitor; SOE = strength of evidence; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

From: Results

Cover of Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update
Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 207.
Forman-Hoffman V, Middleton JC, Feltner C, et al.

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