Pharmacotherapy of posttraumatic stress disorder: a review of meta-analyses and treatment guidelines

A number of randomized controlled trials of the pharmacotherapy of posttraumatic stress disorder (PTSD) are now available. Several meta-analyses of these trials, and a number of consensus guidelines on the treatment of PTSD, have been published. Assessment of these meta-analyses and guidelines provides an opportunity to review the strengths and weaknesses of the evidence-base.

Meta-analyses of PTSD trials were assessed with the quality of reporting of meta-analyses (QUOROM) statement and the Oxman and Guyatt rating scale, and consensus statements on the treatment of PTSD were assessed with the Appraisal of Guidelines Research and Evaluation instrument. Summary statistics of meta-analyses and conclusions of guidelines were tabulated.

The quality of PTSD meta-analyses and guidelines is generally acceptable. Many consensus guidelines have emphasized the value of pharmacotherapy for PTSD. Consensus statements have, however, used different approaches, and their conclusions have differed. Many important questions for the field have not yet been adequately researched.

There have been significant advances in the pharmacotherapy of PTSD, and certain medications (eg, selective serotonin reuptake inhibitors) are appropriately viewed as a first-line treatment for adult PTSD. Nevertheless, as is the case in other anxiety disorders, there is a paucity of longer-term trials, data on treatment effectiveness in wider clinical practice, and data on treatment-resistant patients.