Post-traumatic stress disorder – Clinical Evidence BMJ

Post-traumatic stress disorder

New evidence; conclusions changed for:

Fluoxetine to treat PTSD Two RCTs added found no significant difference between fluoxetine and placebo in PTSD symptoms at the end of treatment (8–12 weeks).
One of the RCTs also found no significant difference between fluoxetine and placebo in the proportion of people no longer meeting diagnostic criteria for PTSD at the end of treatment. One RCT compared fluoxetine versus eye movement desensitisation and reprocessing (EMDR). It found no significant difference between treatments in PTSD symptoms at the end of treatment. However, EMDR was found to be more effective at sustaining improvement in symptoms at 6 months compared with fluoxetine. Evidence added at update suggests effects of fluoxetine in treating PTSD are unclear. Categorisation changed (from Likely to be beneficial to Unknown effectiveness).

New evidence; conclusion confirmed for:

Antiepileptic drugs to prevent PTSD One small RCT added found that a similar proportion of people with a severe injury was diagnosed with PTSD at 4 months’ follow-up after initial treatment with gabapentin for 14 days compared with those given placebo. The RCT was underpowered to detect a clinically meaningful difference. Categorisation unchanged (Unknown effectiveness).

Antihypertensive drugs to prevent PTSD One small RCT added found that the proportion of people with severe injury diagnosed with PTSD at 4 months’ follow-up after initial treatment with propranolol for 14 days was the same as that for those given placebo. The RCT was underpowered to detect a clinically meaningful difference. Categorisation unchanged (Unknown effectiveness).

Antiepileptic drugs to treat PTSD Two RCTs added assessing the effects of topiramate and tiagabine found no significant difference between the antiepileptic drugs assessed and placebo in PTSD symptoms at the end of treatment.
Categorisation unchanged (Unknown effectiveness).

CBT to treat PTSD Three RCTs added, which found that CBT improved PTSD symptoms compared with no treatment.

One RCT added comparing CBT (prolonged exposure) versus present-centred therapy found greater improvements in PTSD symptoms immediately after treatment and at 3 months’ follow-up with CBT. However, there was no significant difference between groups in PTSD symptoms at 6 months. The proportion of women no longer meeting diagnostic criteria for PTSD was larger immediately after treatment with CBT than with present-centred therapy. Categorisation unchanged (Beneficial).

Eye movement desensitisation and reprocessing to treat PTSD One small RCT added found that eye movement desensitisation and reprocessing (EMDR) improved symptoms of PTSD and reduced the proportion of people fulfilling criteria for PTSD compared with no treatment. One RCT comparing EMDR versus fluoxetine found no significant difference between treatments in PTSD symptoms at the end of treatment. However, EMDR was found to be more effective at sustaining improvement in symptoms at 6 months compared with fluoxetine. Categorisation unchanged (Beneficial).

Sertraline to treat PTSD One RCT added found no significant difference between sertraline and placebo in PTSD symptoms at 12 weeks.Categorisation unchanged (Unknown effectiveness).

http://clinicalevidence.bmj.com/ceweb/conditions/meh/1005/1005.jsp?rss=true

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