ABSTRACT

Background: Pharmacological approaches are widely used for post-traumatic stress disorder (PTSD) despite uncertainty over efficacy.

Objectives: To determine the efficacy of all pharmacological approaches, including monotherapy, augmentation and head-to-head approaches (drug versus drug, drug versus psychotherapy), in reducing PTSD symptom severity.

Method: A systematic review and meta-analysis of randomised controlled trials were undertaken; 115 studies were included.

Results: Selective serotonin reuptake inhibitors (SSRIs) were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.28, 95% CI −0.39 to −0.17). For individual monotherapy agents compared to placebo in two or more studies, we found small statistically significant evidence for the antidepressants fluoxetine, paroxetine, sertraline, venlafaxine and the antipsychotic quetiapine. For pharmacological augmentation, we found small statistically significant evidence for prazosin and risperidone.

Conclusions: Some medications have a small positive effect on reducing PTSD symptom severity and can be considered as potential monotherapy treatments; these include fluoxetine, paroxetine, sertraline, venlafaxine and quetiapine. Two medications, prazosin and risperidone, also have a small positive effect when used to augment pharmacological monotherapy. There was no evidence of superiority for one intervention over another in the small number of head-to-head comparison studies.

摘要

背景：尽管疗效不确定，但药理学方法被广泛用于治疗创伤后应激障碍（PTSD）。

目的：确定所有药理学方法，包括单一疗法、增强疗法和头对头疗法（药物与药物、药物与心理治疗）在减轻 PTSD 症状严重程度方面的功效。

方法：对随机对照试验进行系统回顾和荟萃分析；纳入了 115 项研究。

结果：发现选择性血清素再摄取抑制剂（SSRI）在减少 PTSD 症状方面在统计学上优于安慰剂，但效果较小（标准化平均差 -0.28，95% CI -0.39 至 -0.17）。在两项或多项研究中，对于单独的单药治疗药物与安慰剂的比较，我们发现抗抑郁药氟西汀、帕罗西汀、舍曲林、文拉法辛和抗精神病药喹硫平的统计显着性证据很少。对于药理学增强作用，我们发现哌唑嗪和利培酮的统计上显着的证据很少。

结论：一些药物对减轻 PTSD 症状严重程度具有较小的积极作用，可被视为潜在的单一疗法；这些药物包括氟西汀、帕罗西汀、舍曲林、文拉法辛和喹硫平。哌唑嗪和利培酮这两种药物在用于增强药物单一疗法时也有轻微的积极作用。在少量的头对头比较研究中，没有证据表明一种干预措施优于另一种干预措施。