Post-traumatic stress disorder (
PTSD) is a common
mental disorder associated with significant distress and reduced functioning. Its occurrence after a severe traumatic event and association with characteristic neurobiological changes make
PTSD a good candidate for pharmacological prevention and early treatment. The primary aim for this systematic review and meta-analysis was to assess whether pharmacological interventions when compared to placebo, or other pharmacological/psychosocial interventions resulted in a clinically significant reduction or prevention of symptoms, improved functioning or quality of life, presence of disorder, or adverse effects. A systematic search was undertaken to identify RCTs, which used early
pharmacotherapy (within three months of a traumatic event) to prevent and treat
PTSD and
acute stress disorder (ASD) in children and adults. Using Cochrane Collaboration methodology, RCTs were identified and rated for risk of bias. Available data was pooled to calculate risk ratios (RR) for
PTSD prevalence and standardised mean differences (SMD) for
PTSD severity. 19 RCTs met the inclusion criteria; 16 studies with adult participants and three with children. The methodological quality of most trials was low. Only
hydrocortisone in adults was found to be superior to placebo (3 studies, n = 88, RR: 0.21 (CI 0.05 to 0.89)) although this was in populations with severe physical illness, raising concerns about generalisability. No significant effects were found for the other
pharmacotherapies investigated (
propranolol,
oxytocin,
gabapentin,
fish oil (1470 mg DHA/147 mg EPA),
fish oil (224 mg DHA/22.4 mg EPA),
dexamethasone,
escitalopram,
imipramine and
chloral hydrate).
Hydrocortisone shows the most promise, of
pharmacotherapies subjected to RCTs, as an emerging intervention in the prevention of
PTSD within three months after
trauma and should be a target for further investigation. The limited evidence for
hydrocortisone and its adverse effects mean it cannot be recommended for routine use, but, it could be considered as a preventative intervention for people with severe physical illness or injury, shortly after a traumatic event, as long as there are no
contraindications. More research is needed using larger, high quality RCTs to establish the most efficacious use of
hydrocortisone in different populations and optimal dosing, dosing window and route. There is currently a lack of evidence to suggest that other pharmacological agents are likely to be effective.