OBJECTIVE:Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD. METHOD:Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment. RESULTS: Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences. CONCLUSIONS: Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods.
RCT Entities:
OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD. METHOD: Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment. RESULTS:Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences. CONCLUSIONS: Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods.
Authors: Sandro Galea; David Vlahov; Heidi Resnick; Jennifer Ahern; Ezra Susser; Joel Gold; Michael Bucuvalas; Dean Kilpatrick Journal: Am J Epidemiol Date: 2003-09-15 Impact factor: 4.897
Authors: J Davidson; T Pearlstein; P Londborg; K T Brady; B Rothbaum; J Bell; R Maddock; M T Hegel; G Farfel Journal: Am J Psychiatry Date: 2001-12 Impact factor: 18.112
Authors: Charles B Nemeroff; J Douglas Bremner; Edna B Foa; Helen S Mayberg; Carol S North; Murray B Stein Journal: J Psychiatr Res Date: 2005-10-18 Impact factor: 4.791
Authors: Michael W Otto; Devon Hinton; Nicole B Korbly; Andrea Chea; Phalnarith Ba; Beth S Gershuny; Mark H Pollack Journal: Behav Res Ther Date: 2003-11
Authors: Sheila A M Rauch; H Myra Kim; Corey Powell; Peter W Tuerk; Naomi M Simon; Ron Acierno; Carolyn B Allard; Sonya B Norman; Margaret R Venners; Barbara O Rothbaum; Murray B Stein; Katherine Porter; Brian Martis; Anthony P King; Israel Liberzon; K Luan Phan; Charles W Hoge Journal: JAMA Psychiatry Date: 2019-02-01 Impact factor: 21.596
Authors: A Lowell; B Suarez-Jimenez; L Helpman; X Zhu; A Durosky; A Hilburn; F Schneier; R Gross; Y Neria Journal: Psychol Med Date: 2017-08-14 Impact factor: 7.723
Authors: Xi Zhu; Benjamin Suarez-Jimenez; Amit Lazarov; Liat Helpman; Santiago Papini; Ari Lowell; Ariel Durosky; Martin A Lindquist; John C Markowitz; Franklin Schneier; Tor D Wager; Yuval Neria Journal: Depress Anxiety Date: 2018-09-10 Impact factor: 6.505
Authors: Michael B VanElzakker; M Kathryn Dahlgren; F Caroline Davis; Stacey Dubois; Lisa M Shin Journal: Neurobiol Learn Mem Date: 2013-12-07 Impact factor: 2.877