PTSD Responds to Mix to Drugs, Psychotherapy. (Consider CBT, SSRI)
Jancin, Bruce, Clinical Psychiatry News
ASPEN, COLO. -- The state of therapeutics in postrraumatic stress disorder can be described in a word as confusing, Dr. John A. Talbott said at a psychiatry conference sponsored by the University of Colorado.
"Frankly, it's a mess," he said. "The literature is not great. But it's an intriguing field in many ways. It's ever-evolving. It's so different than it was 20 or 30 years ago."
Dr. Talbott is a Vietnam veteran with a career-long special interest in posttraumatic stress disorder (PTSD) and a close follower of the PTSD literature from his experience as editor-in-chief of the "Year Book of Psychiatry and Applied Mental Health" for more than 20 years. He summarized the data on treatment effectiveness as follows: Almost all of the dozens of forms of psychotherapy and pharmacotherapy that have been evaluated for PTSD work somewhat. Nothing stands out as strikingly more effective than anything else. A combined approach involving psychotherapy and medication is probably more effective than either treatment alone.
"You've got to use multiple treatments. Know one form of psychotherapy--I would suggest cognitive behavioral therapy--and one medication well," advised Dr. Talbott, professor of psychiatry at the University of Maryland, Baltimore, and former president of the American Psychiatric Association.
Among drug therapies, the selective serotonin reuptake inhibitors are the preferred first choice, according to a 1999 expert consensus panel. A more recent Cochrane Collaboration review concluded that SSRIs and carbamazepine have demonstrated the greatest efficacy, although the anticonvulsant was supported by a single trial.
The review went on to state that psychologic therapies for PTSD have a significantly lower patient dropout rate than pharmacotherapies, by a margin of 14% vs. …