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Meta-Analysis
. 2010 Jul 7;2010(7):CD007316.
doi: 10.1002/14651858.CD007316.pub2.

Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD)

Sarah E Hetrick  1 , Rosemary Purcell, Belinda Garner, Ruth Parslow
Affiliations
Meta-Analysis

Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD)

Sarah E Hetrick et al. Cochrane Database Syst Rev. .

Abstract

Background: PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone.

Objectives: To assess whether the combination of psychological therapy and pharmacotherapy provides a more efficacious treatment for PTSD than either of these interventions delivered separately.

Search strategy: Searches were conducted on the trial registers kept by the CCDAN group (CCDANCTR-Studies and CCDANCTR-References) to June 2010. The reference sections of included studies and several conference abstracts were also scanned.

Selection criteria: Patients of any age or gender, with chronic or recent onset PTSD arising from any type of event relevant to the diagnostic criteria were included. A combination of any psychological therapy and pharmacotherapy was included and compared to wait list, placebo, standard treatment or either intervention alone. The primary outcome was change in total PTSD symptom severity. Other outcomes included changes in functioning, depression and anxiety symptoms, suicide attempts, substance use, withdrawal and cost.

Data collection and analysis: Two or three review authors independently selected trials, assessed their 'risk of bias' and extracted trial and outcome data. We used a fixed-effect model for meta-analysis. The relative risk was used to summarise dichotomous outcomes and the mean difference and standardised mean difference were used to summarise continuous measures.

Main results: Four trials were eligible for inclusion, one of these trials (n =24) was on children and adolescents. All used an SSRI and prolonged exposure or a cognitive behavioural intervention. Two trials compared combination treatment with pharmacological treatment and two compared combination treatment with psychological treatment. Only two trials reported a total PTSD symptom score and these data could not be combined. There was no strong evidence to show if there were differences between the group receiving combined interventions compared to the group receiving psychological therapy (mean difference 2.44, 95% CI -2.87, 7.35 one study, n=65) or pharmacotherapy (mean difference -4.70, 95% CI -10.84 to 1.44; one study, n = 25). Trialists reported no significant differences between combination and single intervention groups in the other two studies. There were very little data reported for other outcomes, and in no case were significant differences reported.

Authors' conclusions: There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone. Further large randomised controlled trials are urgently required.

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Conflict of interest statement

No declarations of interest.

Figures

1.1
1.1. Analysis
Comparison 1 Combined SSRI plus CBT versus SSRI alone (adults), Outcome 1 PTSD symptom severity (clinician rated) post intervention (final scores SIP).
1.2
1.2. Analysis
Comparison 1 Combined SSRI plus CBT versus SSRI alone (adults), Outcome 2 Drop outs.
1.3
1.3. Analysis
Comparison 1 Combined SSRI plus CBT versus SSRI alone (adults), Outcome 3 Depression severity (self rated) post intervention (change scores).
1.4
1.4. Analysis
Comparison 1 Combined SSRI plus CBT versus SSRI alone (adults), Outcome 4 Anxiety severity (self rated) post intervention (change scores).
2.1
2.1. Analysis
Comparison 2 Combined SSRI plus CBT versus PE alone (adults), Outcome 1 PTSD symptom severity (clinician rated) post intervention (change scores SPRINT).
2.2
2.2. Analysis
Comparison 2 Combined SSRI plus CBT versus PE alone (adults), Outcome 2 Drop outs.
3.1
3.1. Analysis
Comparison 3 Combined SSRI plus TFCBT versus TFCBT alone (children/adolescents), Outcome 1 Drop outs.
3.2
3.2. Analysis
Comparison 3 Combined SSRI plus TFCBT versus TFCBT alone (children/adolescents), Outcome 2 Functioning CGAS.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

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References to ongoing studies

Gamito 2005 {published data only}
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