Pharmacotherapy for post-traumatic stress disorder: Systematic
                        review and meta-analysis

BackgroundPharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.AimsTo determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability.MethodA systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included.ResultsSelective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.ConclusionsSome drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

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Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis

European Psychiatry ◽

10.1192/j.eurpsy.2019.7 ◽

2020 ◽

Vol 63 (1) ◽

Cited By ~ 5

Author(s):

Steinn Steingrimsson ◽

Gorana Bilonic ◽

Ann-Catrin Ekelund ◽

Tomas Larson ◽

Ida Stadig ◽

...

Keyword(s):

Systematic Review ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Meta Analysis ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Suicidal Thoughts ◽

Assessment Development ◽

Post Traumatic

Abstract Background. Post-traumatic stress disorder (PTSD) is debilitating for patients and society. There are a number of treatment methods albeit not all patients respond to these and an interesting method using electroencephalography-based neurofeedback (EEG-NF) has become more prominent in recent years. This systematic review aimed to assess whether EEG-NF, compared with sham NF, other treatment, or no treatment, is effective for PTSD. Primary outcomes were self-harm, PTSD symptoms, level of functioning and health-related quality of life. Methods. Systematic literature searches for randomized controlled trials (RCTs) were conducted in six databases. Random effects meta-analysis was performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Results. Four RCTs were included (123 participants). Suicidal thoughts were significantly reduced after EEG-NF compared with a waiting list in a small study. PTSD symptoms were assessed in all studies with different instruments. Results were consistently in favor of EEG-NF with large effect sizes (standardized mean difference −2.30 (95% confidence interval: −4.37 to −0.24). One study reported significantly improved level of executive functioning and one study a reduction in use of psychotropic medication. Complications were scarcely reported. Certainty of evidence was assessed as very low for the four assessed outcomes. Conclusions. Based on four RCTs, with several study limitations and imprecision, it is uncertain whether EEG-NF reduces suicidal thoughts, PTSD symptoms, medication use, or improves function. Although all studies showed promising results, further studies are needed to increase the certainty of evidence.

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Prazosin for treatment of post-traumatic stress disorder: a systematic review and meta-analysis

CNS Spectrums ◽

10.1017/s1092852920001121 ◽

2020 ◽

pp. 1-7

Author(s):

Christopher Reist ◽

Elani Streja ◽

Cynthia Crystal Tang ◽

Bryan Shapiro ◽

Jim Mintz ◽

...

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Sleep Disturbances ◽

Stress Disorder ◽

Meta Analysis ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Abstract Background. Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD. Methods. A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges’ g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies. Results. Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD = −0.31; 95% confidence intervals [CI]: −0.62, −0.01), nightmares (SMD = −0.75; 95% CI: −1.24, −0.27), and sleep quality (SMD = −0.57; 95% CI: −1.02, −0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences. Conclusions. Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.

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