Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review
DOI:
https://doi.org/10.25118/2763-9037.2023.v13.1037Keywords:
Post-traumatic stress disorder, pharmacology, Psychopharmacology, stress disorders, post-traumatic, drug therapyAbstract
Objective: To review the literature from the last twenty years on pharmacological treatments for post-traumatic stress disorder to clarify questions about the efficacy and tolerability of pharmacotherapy and the superiority of one specific agent over another for creating a treatment guideline based on levels of evidence. Methods: Randomized clinical trials and systematic reviews were searched in Medline-PubMed, PsycINFO, Web of Science, Scielo, and Lilacs. The screening of the criteria established by the Transparent Reporting of Systematic Reviews and Meta-Analyses was used, followed by the analysis of risk of bias of the Critical Appraisal Skills Programme. Lastly, the level of evidence and grade of recommendation was acquired, following the Oxford Center for Evidence-based Medicine 2009 Levels of Evidence. Results: The search retrieved double-blind, randomized and placebo-controlled clinical trials. Comparative clinical trials between different drugs were also evaluated and systematic reviews on drug efficacy and meta-analyses. A total of 1.458 studies were found; 58 of these studies were pre-selected and the final sample was composed of 20 studies. Conclusions: Of the 17 drugs included, the following is the order of recommendation based on the levels of evidence established in this study - 1st sertraline; 2nd venlafaxine and paroxetine; 3rd atypical antipsychotics.
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American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais: DSM-5. 5. ed. Porto Alegre: Artmed; 2014.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-60. https://doi.org/10.1001/archpsyc.1995.03950240066012 - PMID:7492257
Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey. N Engl J Med. 1987;317(26):1630-4. https://doi.org/10.1056/nejm198712243172604 - PMID:3683502
Lancaster CL, Teeters JB, Gros DF, Back SE. Posttraumatic stress disorder: overview of evidence-based assessment and treatment. J Clin Med. 2016;5(11):105. https://doi.org/10.3390/jcm5110105 PMID:27879650 - PMCID:PMC5126802
Luz MP, Coutinho ES, Berger W, Mendlowicz MV, Vilete LM, Mello MF, Quintana MI, Bressan RA, Andreoli SB, Mari JJ, Figueira I. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011 - PMID:26540404
Forbes D, Bisson JI, Monson CM, Berliner L, editors. Effective treatments for PTSD: practice guidelines from the international society for traumatic stress studies. 3rd ed. New York: Guilford Press; 2020.
American Psychiatric Association. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Washington: American Psychiatric Association; 2017. Background and justification: the scope of the problem; p. 6-11. https://www.apa.org/ptsd-guideline/ptsd.pdf
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71 - PMID:33782057 - PMCID:PMC8005924
Critical Appraisal Skills Programme. Critical Appraisal Checklists. Oxford: Critical Appraisal Skills Programme; c2023. https://casp-uk.net/casp-tools-checklists/
Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M. Oxford Centre for Evidence-Based Medicine: levels of evidence (March 2009). Howick J, updated. Oxford: University of Oxford; 2009. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009
Han C, Pae CU, Wang SM, Lee SJ, Patkar AA, Masand PS, Serretti A. The potential role of atypical antipsychotics for the treatment of posttraumatic stress disorder. J Psychiatr Res. 2014;56:72-81. https://doi.org/10.1016/j.jpsychires.2014.05.003- PMID:24882700
Becker ME, Hertzberg MA, Moore SD, Dennis MF, Bukenya DS, Beckham JC. A placebo-controlled trial of bupropion SR in the treatment of chronic posttraumatic stress disorder. J Clin Psychopharmacol. 2007;27(2):193-7. https://doi.org/10.1097/jcp.0b013e318032eaed PMID:17414245
Orsolini L, Chiappini S, Volpe U, Berardis D, Latini R, Papanti GD, Corkery AJM. Use of medicinal cannabis and synthetic cannabinoids in post-traumatic stress disorder (PTSD): a systematic review. Medicina (Kaunas). 2019;55(9):525.https://doi.org/10.3390/medicina55090525 PMID:31450833 - PMCID:PMC6780141
Davis LL, Davidson JR, Ward LC, Bartolucci A, Bowden CL, Petty F. Divalproex in the treatment of posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial in a veteran population. J Clin Psychopharmacol. 2008;28(1):84-8. https://doi.org/10.1097/jcp.0b013e318160f83b - PMID:18204347
Martenyi F, Brown EB, Caldwell CD. Failed efficacy of fluoxetine in the treatment of posttraumatic stress disorder: results of a fixed-dose, placebo-controlled study. J Clin Psychopharmacol. 2007;27(2):166-70. https://doi.org/10.1097/jcp.0b013e31803308ce PMID:17414240
Rasmusson AM, Marx CE, Jain S, Farfel GM, Tsai J, Sun X, Geracioti TD, Hamner MB, Lohr J, Rosse R, Summerall L, Naylor JC, Cusin C, Lang AJ, Raman R, Stein MB. A randomized controlled trial of ganaxolone in posttraumatic stress disorder. Psychopharmacology (Berl). 2017;234(15):2245-57. https://doi.org/10.1007/s00213-017-4649-y - PMID:28667510
Feder A, Parides MK, Murrough JW, Perez AM, Morgan JE, Saxena S, Kirkwood K, Aan Het Rot M, Lapidus KA, Wan LB, Iosifescu D, Charney DS. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(6):681-8. https://doi.org/10.1001/jamapsychiatry.2014.62 - PMID:24740528
Marshall RD, Beebe KL, Oldham M, Zaninelli R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001;158(12):1982-8. https://doi.org/10.1176/appi.ajp.158.12.1982 - PMID:11729013
Singh B, Hughes AJ, Mehta G, Erwin PJ, Parsaik AK. Efficacy of prazosin in posttraumatic stress disorder: a systematic review and meta-analysis. Prim Care Companion CNS Disord. 2016;18(4). https://doi.org/10.4088/pcc.16r01943 - PMID:27828694
Baniasadi M, Hosseini G, Fayyazi Bordbar MR, Rezaei Ardani A, Mostafavi Toroghi H. Effect of pregabalin augmentation in treatment of patients with combat-related chronic posttraumatic stress disorder: a randomized controlled trial. J Psychiatr Pract. 2014;20(6):419-27. https://doi.org/10.1097/01.pra.0000456590.12998.41 - PMID:25406046
Brunet A, Saumier D, Liu A, Streiner DL, Tremblay J, Pitman RK. Reduction of PTSD symptoms with pre-reactivation propranolol therapy: a randomized controlled trial. Am J Psychiatry. 2018;175(5):427-33. https://doi.org/10.1176/appi.ajp.2017.17050481 - PMID:29325446
Villarreal G, Hamner MB, Canive JM, Robert S, Calais LA, Durklaski V, Zhai Y, Qualls C. Efficacy of quetiapine monotherapy in posttraumatic stress disorder: a randomized, placebo-controlled trial. Am J Psychiatry. 2016;173(12):1205-12. https://doi.org/10.1176/appi.ajp.2016.15070967 PMID:27418378
Rezaei Ardani A, Hosseini G, Fayyazi Bordbar MR, Talaei A, Mostafavi Toroghi H. Effect of rivastigmine augmentation in treatment of male patients with combat-related chronic posttraumatic stress disorder: a randomized controlled trial. J Clin Psychopharmacol. 2017;37(1):54-60. https://doi.org/10.1097/jcp.0000000000000624 - PMID:27930500
Li W, Ma YB, Yang Q, Li BL, Meng QG, Zhang Y. Effect and safety of sertraline for treat posttraumatic stress disorder: a multicenter randomised controlled study. Int J Psychiatry Clin Pract. 2017;21(2):151-5. https://doi.org/10.1080/13651501.2017.1291838 - PMID:28266242
Panahi Y, Moghaddam BR, Sahebkar A, Nazari MA, Beiraghdar F, Karami G, Saadat AR. A randomized, double-blind, placebo-controlled trial on the efficacy and tolerability of sertraline in Iranian veterans with post-traumatic stress disorder. Psychol Med. 2011;41(10):2159-66. https://doi.org/10.1017/s0033291711000201 - PMID:21349225
Davidson JR, Rothbaum BO, van der Kolk BA, Sikes CR, Farfel GM. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58(5):485-92. https://doi.org/10.1001/archpsyc.58.5.485 - PMID:11343529
Davidson JR, Brady K, Mellman TA, Stein MB, Pollack MH. The efficacy and tolerability of tiagabine in adult patients with post-traumatic stress disorder. J Clin Psychopharmacol. 2007;27(1):85-8. https://doi.org/10.1097/jcp.0b013e31802e5115 - PMID:17224720
Varma A, Moore MB, Miller CWT, Himelhoch S. Topiramate as monotherapy or adjunctive treatment for posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2018;31(1):125-33. https://doi.org/10.1002/jts.22251 - PMID:29388709
Davidson J, Rothbaum BO, Tucker P, Asnis G, Benattia I, Musgnung JJ. Venlafaxine extended release in posttraumatic stress disorder: a sertraline- and placebo-controlled study. J Clin Psychopharmacol. 2006;26(3):259-67. https://doi.org/10.1097/01.jcp.0000222514.71390.c1 PMID:16702890
Davidson J, Baldwin D, Stein DJ, Kuper E, Benattia I, Ahmed S, Pedersen R, Musgnung J. Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Arch Gen Psychiatry. 2006;63(10):1158-65. https://doi.org/10.1001/archpsyc.63.10.1158 - PMID:17015818
Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications . 4th ed. New York: Cambridge University Press; 2013.
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Copyright (c) 2023 Cauê do Prado Nascimento, Heitor Zuleta Couto, Leonardo Baldaçara, Antônio Geraldo da Silva, Marcelo Feijó́ de Mello; Andrea Feijó́ de Mello
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Grant numbers Processo nº 2020/14814-3
