Background: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD). Objectives: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy. Method: To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported. Results: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53–1.22) rather than unmedicated (g = 0.27; 95% CI 0.01–0.54, p = 0.017), with younger age (b₁ = −0.04, p = 0.008) and higher proportion of females (b₁ = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up. Conclusions: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.
Psychother Psychosom

中文翻译：

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无论是否同时服用精神药物，成人创伤后应激障碍的心理干预都是有效的：随机对照试验的荟萃分析

背景：在大多数检查成人创伤后应激障碍 (PTSD) 心理干预的试验中，允许参与者继续服用处方精神药物。目标：我们的目的是进行第一项荟萃分析，调查此类同时用药对疗效的潜在影响。方法：为此，我们搜索了从开始到 2022 年 4 月 21 日的 Medline、PsycINFO、Web of Science 和 PTSDpubs，寻找满足以下标准的试验：(1) 随机对照试验 (RCT)，(2) PTSD 作为主要治疗重点，（3）基于访谈的 PTSD 基线率≥70%，（4） N≥20，（5）平均年龄≥18 岁。当没有（充分）报告精神药物的摄入量时，试验被排除在外。结果：大多数已发表的试验没有报告精神药物的摄入量。共有 75 项随机对照试验（N = 4,901 名患者）符合纳入标准。以创伤为中心的认知行为疗法 (TF-CBT) 是研究最深入的干预措施。除了一项分析外，心理治疗的短期疗效并没有因参与者在心理治疗期间同时服用精神药物的比例而有所不同。在比较 TF-CBT 和治疗后主动控制条件的试验中，当大多数参与者同时接受药物治疗（g = 0.87，95% CI 0.53–1.22）而不是未接受药物治疗（g = 0.27；95% CI 0.01– 0.54, p = 0.017), 年龄较小 ( b ₁= −0.04，p = 0.008）和更高比例的女性（b ₁ = 0.01，p = 0.014）仅在高比例药物参与者的试验中与更高的疗效相关。随访期间未发现同时服用精神药物的参与者的比例在疗效上存在差异。结论：结果表明心理干预对 PTSD 有效，与同时服用精神药物无关。
心理医生