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Randomized Controlled Trial
. 2018 Dec;213(6):704-708.
doi: 10.1192/bjp.2018.211. Epub 2018 Oct 25.

High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder

Belinda Graham  1 , Natalia M Garcia  2 , Mark S Burton  3 , Andrew A Cooper  4 , Peter P Roy-Byrne  5 , Matig R Mavissakalian  6 , Norah C Feeny  7 , Lori A Zoellner  8
Affiliations
Randomized Controlled Trial

High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder

Belinda Graham et al. Br J Psychiatry. 2018 Dec.

Abstract

Background: Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response.

Method: Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety.

Results: Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response.

Conclusions: Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects.

Declaration of interest: None.

Keywords: Early response; antidepressants; expectancy; post-traumatic stress disorder.

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Conflict of interest statement

Declarations of Interest: None.

Figures

Figure 1.
Figure 1.. Session at which PTSD symptom severity (PSS-SR) reduces by 20%.
Session refers to first occurrence of 20% symptom reduction from pre-treatment. PSS-SR = PTSD Symptom Scale-Self Report.
Figure 2.
Figure 2.. Early response predicts good end-state functioning in sertraline only.
Early response was defined as 20% reduction in PTSD symptoms from baseline by Session 2. Good end-state functioning was defined by sub-clinical symptoms across PTSD (PSS-I ≤ 20), depression (BDI ≤ 10), and state anxiety (STAI-S ≤ 40). For prolonged exposure, B = 0.37, t = 0.62, p (ns), 95% CI [−0.55, 1.30]; for sertraline, B = 2.55, t = 14.88, p < .001, 95% CI [1.26, 3.85].
Figure 3.
Figure 3.. Pre-treatment PTSD severity and expectancy predicting early response by treatment condition.
Higher pre-treatment PTSD severity predicted early response in PE but not sertraline. Higher expectancy predicted early response in sertraline but not PE. Values represent estimated likelihood of early response for patients with low (25th percentile), medium (50th percentile) and high (75th percentile) pre-treatment PTSD severity or expectancy, separated by treatment type. PSS-I = PTSD Symptom Scale – Interview. For pre-treatment PTSD severity, in prolonged exposure, B = −1.11, p < .001, 95% CI [−1.72, −0.49] and in sertraline, B = −0.31, p (ns), 95% CI [−0.88, 0.26]. For expectancy of therapeutic outcome, in prolonged exposure, B = 0.26, p (ns), 95% CI [−0.29, 0.81] and in sertraline, B = 1.35, p = .01, 95% CI [0.35, 2.36].
See this image and copyright information in PMC

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