Comorbidity of mood and
anxiety disorders is common in patients suffering from
post-traumatic stress disorder (
PTSD). The current study evaluated the efficacy and tolerability of
sertraline in a subgroup of
PTSD patients suffering from anxiety or depression comorbidity. Two multicenter, 12-week, double-blind, flexible-dose US studies of adult outpatients from the general population with a DSM-III-R diagnosis of
PTSD evaluated the safety and efficacy of
sertraline (50 to 200 mg/d) compared to placebo in the treatment of
PTSD. The total severity score of the Clinician-Administered
PTSD Scale (CAPS-2) and the Davidson
Trauma Scale (DTS) were used to examine the effect of comorbidity on treatment outcome. Among the combined 395 subjects enrolled in the two trials, 32.9% had a comorbid depressive diagnosis (no anxiety diagnosis), 6.3% had a comorbid
anxiety disorder diagnosis (no depression), 11.4% had both a depression and
anxiety disorder diagnosis, and 49.4% had no comorbidity. The correlation, at baseline, between Hamilton Depression Rating Scale (HAM-D) total score and the three CAPS-2 clusters was 0.37 for the re-experiencing/intrusion cluster, 0.52 for the avoidance/numbing cluster, and 0.45 for the hyperarousal cluster. Patients suffering from
PTSD complicated by a current diagnosis of both depression and an
anxiety disorder showed the highest baseline CAPS-2 cluster score severity. Patients treated with
sertraline improved significantly (P <.05) compared to placebo on both the CAPS-2 and DTS whether or not they had a comorbid depressive or
anxiety disorder.
Sertraline was well tolerated. The presence of comorbidity was associated with a modest and mostly nonspecific increase in the side effect burden of approximately 10% to 20% on both study treatments. Patients suffering from dual depression and
anxiety disorder comorbidity benefited from somewhat higher doses (147 mg v 125 mg; P =.08). Similarly, the presence of dual comorbidity resulted in a modest but nonsignificant increase in the mean time to response from 4.5 weeks to 5.5 weeks. We conclude that
sertraline (50 to 200 mg/d) is effective and well tolerated in the treatment of
PTSD for patients suffering from a current, comorbid depressive or
anxiety disorders.