Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial.

Abstract

OBJECTIVE:

Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD.

METHOD:

Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment.

RESULTS:

Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences.

CONCLUSIONS:

Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods.

• Authors: Franklin R Schneier, Yuval Neria, Martina Pavlicova, Elizabeth Hembree, Eun Jung Suh, Lawrence Amsel, Randall D Marshall
• Journal: The American journal of psychiatry (Am J Psychiatry) Vol. 169 Issue 1 Pg. 80-8 (Jan 2012) ISSN: 1535-7228 [Electronic] United States
• PMID: 21908494 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Serotonin Uptake Inhibitors
• Paroxetine

Topics

• Combined Modality Therapy
• Double-Blind Method
• Female
• Humans
• Implosive Therapy (methods)
• Male
• Middle Aged
• New York City
• Paroxetine (therapeutic use)
• Psychiatric Status Rating Scales
• September 11 Terrorist Attacks (psychology)
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Stress Disorders, Post-Traumatic (drug therapy, therapy)
• Treatment Outcome