Several psychological and pharmacological therapies were found to have at least moderate strength of evidence supporting their effectiveness in the treatment of posttraumatic stress disorder (PTSD), according to a new systematic review.

To update a previous review, researchers searched various databases from May 2012 to September 2017 to identify studies comparing the safety and efficacy of various PTSD interventions; 193 randomized controlled trials met the inclusion criteria. 

With regard to psychological therapies, cognitive behavioral therapy (CBT)-exposure and CBT-mixed treatments were associated with a reduction in PTSD symptoms and resolution of PTSD when compared with inactive comparators (high strength of evidence). In addition, cognitive processing therapy, cognitive therapy, eye movement desensitization and reprocessing, and narrative exposure therapy were also found to be effective (moderate strength of evidence). When CBT-exposure was compared to relaxation therapy, there was moderate strength evidence to support CBT-exposure. 

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As for pharmacological treatment, the use of fluoxetine, paroxetine, and venlafaxine was found to be more effective in reducing PTSD symptoms than placebo (moderate strength of evidence). A network meta-analysis of 33 trials (N=4817) found no significant differences in effectiveness between these 3 drugs, however most of the evidence came from indirect comparisons.

Most of the studies involving psychological therapies did not report on adverse events, while trials evaluating drug therapy did not appear to be associated with any serious adverse events. In addition, no conclusions could be made regarding differences in treatment benefits based on patient characteristics or the nature of trauma exposure.

“Additional studies that directly compare psychological to pharmacological treatments are needed to confirm or refute which treatments are truly more effective first-line treatments,” the authors write.

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