For the treatment of post-traumatic stress disorder (PTSD), a new meta-analysis found pharmacological, psychotherapeutic, and combination approaches equally effective at the end of treatment. But over the long term, psychotherapeutic and combination treatments appeared more effective than pharmacologic approaches alone.
Researchers published their findings online in JAMA Psychiatry.
“Our results indicate that there is no superiority of any treatment approach at the end of treatment; however, we found evidence for the superiority of psychotherapeutic over pharmacological treatments, and of combined treatments over pharmacological treatments alone at the last available follow-up,” researchers wrote. “With regard to treatment acceptability, we did not find significant differences between the three treatment approaches.”
The network meta-analysis covered 12 randomized clinical trials that included 922 adults with PTSD and 23 direct comparisons of pharmacological, psychotherapeutic, and combined treatments.
Analysis revealed similar findings for pharmacological, psychotherapeutic, and combined approaches at treatment end. Yet in 6 randomized clinical trials with follow-up data, the benefits of psychotherapeutic and combined treatment approaches were superior over the long-term, compared with pharmacological treatment.
“Despite the relatively small number of identified studies, our meta-analyses suggest a consistent pattern of equivalent treatment at the end of treatment across a number of sensitivity analyses including self-reported and observer-reported outcomes, and suggest no urgent need for further evidence on short-term outcomes,” the study concluded. “But, to our knowledge, our meta-analyses using long-term data are the first to empirically confirm the typical recommendation of psychotherapeutic treatments as first-line treatments.”
Researchers added that definite conclusions were hampered by the scarcity of long-term data and that more studies directly comparing long-term outcomes of the 3 approaches are needed.
Merz J, Schwarzer G, Gerger H. Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis. JAMA Psychiatry. 2019 June 12;[Epub ahead of print].