Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review

Authors

  • Cauê do Prado Nascimento Graduando, Faculdade de Medicina, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil https://orcid.org/0000-0002-9574-412X
  • Heitor Zuleta Couto Graduando, Faculdade de Medicina, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil https://orcid.org/0009-0000-4255-9185
  • Leonardo Baldaçara Professor, Universidade Federal do Tocantins, UFT, Palmas, TO, Brasil https://orcid.org/0000-0002-5201-8515
  • Antônio Geraldo da Silva Pós-doutorando, Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, MG, Brasil https://orcid.org/0000-0003-3423-7076
  • Marcelo Feijó de Mello Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil https://orcid.org/0000-0002-0475-4729
  • Andrea Feijó de Mello Coordenadora do Programa de Atendimento e Pesquisa em Violência, PROVE, Universidade Federal de São Paulo, UNIFESP, São Paulo, SP, Brasil https://orcid.org/0000-0001-8498-7751

DOI:

https://doi.org/10.25118/2763-9037.2023.v13.1037

Keywords:

Post-traumatic stress disorder, pharmacology, Psychopharmacology, stress disorders, post-traumatic, drug therapy

Abstract

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.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Cauê do Prado Nascimento, Graduando, Faculdade de Medicina, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil

http://lattes.cnpq.br/5316711720722006

Heitor Zuleta Couto, Graduando, Faculdade de Medicina, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil

http://lattes.cnpq.br/6563515135671163

Leonardo Baldaçara, Professor, Universidade Federal do Tocantins, UFT, Palmas, TO, Brasil

http://lattes.cnpq.br/7014751113831877

Antônio Geraldo da Silva, Pós-doutorando, Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, MG, Brasil

http://lattes.cnpq.br/9471338065453170

Marcelo Feijó de Mello, Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein, FICSAE, São Paulo, SP, Brasil

http://lattes.cnpq.br/9828693113292175

Andrea Feijó de Mello, Coordenadora do Programa de Atendimento e Pesquisa em Violência, PROVE, Universidade Federal de São Paulo, UNIFESP, São Paulo, SP, Brasil

http://lattes.cnpq.br/5024373026936383

References

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 DOI: https://doi.org/10.1001/archpsyc.1995.03950240066012

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 DOI: https://doi.org/10.1056/NEJM198712243172604

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 DOI: https://doi.org/10.3390/jcm5110105

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 DOI: https://doi.org/10.1016/j.jpsychires.2015.10.011

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 DOI: https://doi.org/10.1136/bmj.n71

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 DOI: https://doi.org/10.1016/j.jpsychires.2014.05.003

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 DOI: https://doi.org/10.1097/JCP.0b013e318032eaed

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 DOI: https://doi.org/10.3390/medicina55090525

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 DOI: https://doi.org/10.1097/JCP.0b013e318160f83b

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 DOI: https://doi.org/10.1097/JCP.0b013e31803308ce

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 DOI: https://doi.org/10.1007/s00213-017-4649-y

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 DOI: https://doi.org/10.1001/jamapsychiatry.2014.62

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 DOI: https://doi.org/10.1176/appi.ajp.158.12.1982

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 DOI: https://doi.org/10.4088/PCC.16r01943

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 DOI: https://doi.org/10.1097/01.pra.0000456590.12998.41

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 DOI: https://doi.org/10.1176/appi.ajp.2017.17050481

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 DOI: https://doi.org/10.1176/appi.ajp.2016.15070967

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 DOI: https://doi.org/10.1097/JCP.0000000000000624

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 DOI: https://doi.org/10.1080/13651501.2017.1291838

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 DOI: https://doi.org/10.1017/S0033291711000201

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 DOI: https://doi.org/10.1001/archpsyc.58.5.485

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 DOI: https://doi.org/10.1097/JCP.0b013e31802e5115

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 DOI: https://doi.org/10.1002/jts.22251

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 DOI: https://doi.org/10.1097/01.jcp.0000222514.71390.c1

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 DOI: https://doi.org/10.1001/archpsyc.63.10.1158

Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications . 4th ed. New York: Cambridge University Press; 2013.

Downloads

Published

2023-11-20

How to Cite

1.
Nascimento C do P, Couto HZ, Baldaçara L, Silva AG da, Mello MF de, Mello AF de. Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review . Debates em Psiquiatria [Internet]. 2023 Nov. 20 [cited 2024 Oct. 23];13:1-72. Available from: https://revistardp.org.br/revista/article/view/1037

Issue

Vol. 13 (2023)

Section

Review Articles

License

Copyright (c) 2023 Cauê do Prado Nascimento, Heitor Zuleta Couto, Leonardo Baldaçara, Antônio Geraldo da Silva, Marcelo Feijó́ de Mello; Andrea Feijó́ de Mello

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.

Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:

  • Share — copy and redistribute the material in any medium or format
  • Adapt — remix, transform, and build upon the material

The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • NonCommercial — You may not use the material for commercial purposes.

No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

Crossref
Scopus
Google Scholar
Europe PMC

Plaudit

Funding data

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 7 8 9 10 > >>