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Post-traumatic stress disorder: effectiveness of most therapies is uncertain


Many people, including significant proportions of active duty military personnel and veterans, suffer from post-traumatic stress disorder ( PTSD ), often in conjunction with other injuries or illnesses. While several drugs and psychotherapies are used to treat PTSD, many of the studies concerning their effectiveness have problems; as a result, they do not provide a clear picture of what works and what doesn't, says a new report from the Institute of Medicine.

The researchers reviewed 53 studies of pharmaceuticals and 37 studies of psychotherapies used in PTSD treatment and concluded that because of shortcomings in many of the studies, there is not enough reliable evidence to draw conclusions about the effectiveness of most treatments. There are sufficient data to conclude that exposure therapies, such as exposing individuals to a real or surrogate threat in a safe environment to help them overcome their fears, are effective in treating people with PTSD. But the researchers emphasized that their findings should not be misread to suggest that any PTSD treatment ought to be discontinued or that only exposure therapies should be used to treat PTSD.

PTSD is the most commonly diagnosed service-related mental disorder among military personnel returning from Iraq and Afghanistan. Surveys of these individuals indicate that around 12.6 percent of personnel who fought in Iraq and 6.2 percent who were in Afghanistan have experienced PTSD. Moreover, significant proportions of Vietnam veterans and veterans of earlier conflicts also report suffering from PTSD. The vast majority of people who experience the disorder also have other concurrent conditions, such as alcoholism, depression, drug use, or anxiety disorders. Sexual assault during military service is another factor that can lead to PTSD among service members.

Clinicians turn to both drugs and psychotherapeutic interventions to treat PTSD. Anticonvulsants, antidepressants [ including selective serotonin reuptake inhibitors ( SSRIs ), monoamine oxidase inhibitors ( MAOIs ) ], and novel antipsychotics such as Olanzapine ( Zyprexa ) and Risperidone ( Risperdal ) are among the drugs used to treat these patients.
Psychotherapies used in PTSD treatment include exposure to trauma-related memories or stimuli, cognitive therapy, coping skills training, and hypnosis.

The researchers identified 90 studies that met its criteria for trials from which it could anticipate reliable and informative data on of PTSD therapies. However, several problems and limitations characterize much of the research on PTSD treatments, making the data less informative than expected.
Many of the studies have problems in their design or how they were conducted, and high dropout rates, ranging from 20 percent to 50 percent of participants, reduced the certainty of several studies' results. Moreover, the majority of drug studies were funded by pharmaceutical firms and many of the psychotherapy studies were conducted by individuals who developed the techniques or their close collaborators. Further investigation is needed to know whether these treatments would produce the same results if tested by other researchers and in other settings.

In addition, the research has not taken into account potential differences in the effectiveness of treatments for subgroups such as those with traumatic brain injury, depression, or substance abuse; nor have studies examined the effects in ethnic minorities, women, and older individuals. Many studies excluded individuals with concurrent health problems such as depression and substance abuse, raising questions about whether the results apply to the many PTSD sufferers who have multiple conditions.

Source: The National Academies, 2007

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