Antidepressant treatment of posttraumatic stress disorder and major depression in veterans

Many patients with chronic posttraumatic stress disorder (PTSD) suffer from comorbid major depression. The present study examines the responsiveness of such dual-diagnosis patients to antidepressant medication. Subjects were enrolled in the PTSD medication clinic at the San Diego Veterans Affairs Medical Center. Inclusion criteria were current diagnoses of PTSD and major depression, at least 6 months of regular participation in the clinic, and treatment with antidepressant medication at therapeutic levels and durations. Exclusion criteria were current drug or alcohol abuse, primary psychotic illness, and poor compliance or frequent missed appointments. Among 72 patients meeting inclusion and exclusion criteria, 50% were estimated to be substantially improved, on the basis of Clinical Global Evaluation (CGE) scores of 2 or 1, after remaining on the same antidepressant treatment regimen at therapeutic doses for at least 1 month. Antidepressant medications affecting predominantly serotonin reuptake (sertraline, fluoxetine) were associated with better outcomes than antidepressants affecting predominantly norepinephrine reuptake (nortriptyline, desipramine).