Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis

Post-traumatic stress disorder (PTSD) is a prevalent mental illness with a high disability rate. The neurobiological abnormalities in PTSD suggest that drug therapy may have certain therapeutic effects. According to the recommendations of clinical guidelines for PTSD, the current clinical preference is for selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Nevertheless, the efficacy of other types of drugs remains uncertain, which impacts the selection of personalized treatment for patients.

The aim of this meta-analysis was to assess the efficacy and acceptability of drugs with different pharmacological mechanisms in alleviating PTSD symptoms by comparing the response rates and dropout rates of different drug treatment groups in randomized clinical trials.

Systematic review and meta-analysis.

We searched and analyzed 52 reports that described the efficacy and acceptability of medication for PTSD. Among these, 49 trials used the dropout rate as an acceptability indicator, and 52 trials used the response rate as an efficacy indicator.

In the 49 trials with the dropout rate as the indicator, the dropout rate was 29% (95% confidence interval, 0.26-0.33; n = 3870). In the 52 trials with the response rate as the indicator, the response rate was 39% (95% confidence interval, 0.33-0.45; n = 3808). After drug treatment, the core symptoms of PTSD were significantly improved. This meta-analysis indicated that there was no significant difference between antidepressants and antipsychotics in improving clinical symptoms and acceptability. However, antidepressants may have a slight advantage in efficacy, although with a higher dropout rate.

Drug treatment is an effective rehabilitation method for PTSD patients, and individualized drug management should be considered.

This systematic evaluation scheme has been registered with PROSPERO (protocol ID: CRD42023462662).