A Cochrane review [Abstract] 1 included 35 short-term (14 weeks or less) RCTs with a total of 4 597 subjects. Symptom severity was significantly reduced with medication compared to placebo (WMD -5.76, 95% CI -8.16 to -3.36; 17 trials, n=2 507). Summary statistics for responder status demonstrated overall superiority of a variety of medication agents to placebo (RR 1.49, 95% CI 1.28 to 1.73, NNT=4.85; 13 trials, n=1 272). Medication was superior to placebo in reducing the severity of PTSD symptom clusters, comorbid depression and disability. Medication and placebo response occurred in 59.1% (n=644) and 38.5% (628) of patients, respectively. Evidence of efficacy was most convincing for the SSRIs. Medication was less well tolerated than placebo. A narrative review of 3 maintenance trials suggested that long term medication may be required in treating PTSD.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and indirectness (short follow-up time).
A Cochrane review [Abstract] 2 included 9 RCTs with a total of 345 participants. Participants had been exposed to a variety of traumas, ranging from assault, traffic accidents and work accidents to cardiac surgery and septic shock. There were 4 hydrocortisone studies, 3 propranolol studies and single trials of escitalopram and temazepam. The duration of studies was 12 weeks or less. Outcome assessment measures included the Clinician-Administered PTSD Scale (CAPS), the 36-Item Short-Form Health Survey (SF-36) and the Center for Epidemiological Studies - Depression Scale (CES-D).Hydrocortisone prevented the onset of PTSD (RR 0.17; 95% CI 0.05 to 0.56; p = 0.004; 4 trials, n=165), NNT to prevent the onset of PTSD in one patient was between 7 and 13 patients. Propranolol also prevented the onset of PTSD (RR 0.62; 95% CI 0.24 to 1.59; p = 0.32; 3 trials, n=118). Drop-outs due to treatment-emergent side effects, where reported, were low for all of the agents tested. Three hydrocortisone trials reported that medication was more effective than placebo in reducing PTSD symptoms after a median of 4.5 months after the event. None of the single trials of escitalopram, temazepam and gabapentin demonstrated evidence that medication was superior to placebo in preventing the onset of PTSD.
Comment: The quality oif evidence is downgraded by indirectness (short follow-up time) and imprecise results (few patients for each comparison).
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