Residual symptoms of PTSD following Sertraline plus enhanced medication management, Sertraline plus PE, and PE plus placebo

Psychiatry Res. 2020 Sep:291:113279. doi: 10.1016/j.psychres.2020.113279. Epub 2020 Jul 4.

Abstract

Although prolonged exposure (PE) and SSRI antidepressants are effective in treating posttraumatic stress disorder (PTSD), previous studies have shown that some symptoms tend to persist. The current study compared sertraline hydrochloride plus enhanced medication management (EMM), PE plus placebo, or PE plus sertraline hydrochloride in the likelihood of each individual PTSD symptom persisting in veterans with a PTSD diagnosis. We compared the likelihood of individual PTSD symptoms persisting in those with versus without a PTSD diagnosis at posttreatment. We found no significant differences across conditions in which symptoms were likely to persist posttreatment. Among those without a PTSD diagnosis at posttreatment, sleeping difficulties (63.0%), hypervigilance (47.3%), and nightmares (45.0%) were most likely to persist. Findings indicate no consistent differences in residual symptoms between PE and medications, and shared decision making with patients is encouraged in selecting treatments. Gold standard treatments (e.g., CBT-I) may be warranted for residual symptoms like insomnia.

Keywords: Posttraumatic stress disorder; Psychopharmacology; Psychotherapy; Residual symptoms; Veterans.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / trends
  • Disease Progression*
  • Female
  • Humans
  • Implosive Therapy / methods*
  • Implosive Therapy / trends
  • Male
  • Medication Therapy Management* / trends
  • Middle Aged
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sertraline / therapeutic use*
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy*
  • Treatment Outcome
  • Veterans* / psychology

Substances

  • Antidepressive Agents
  • Serotonin Uptake Inhibitors
  • Sertraline