PTSD: Comparative Effectiveness of Medications, Psychotherapeutic and Combination Treatments Interview with:

Dr. Heike Gerger | Senior Postdoc University of Basel | Faculty of Psychology | Clinical Psychology and Psychotherapy Basel | Switzerland

Dr. Gerger

Dr. Heike Gerger | Senior Postdoc
University of Basel | Faculty of Psychology | Clinical Psychology and Psychotherapy
Basel | Switzerland What is the background for this study?

Response: Posttraumatic stress disorder (PTSD) is one of the most prevalent mental disorders, with a high risk of chronicity, comorbidity, and functional impairment. PTSD is complicated to treat, and the debate on the most efficacious treatment approach is ongoing. Treatment guidelines for the treatment of PTSD typically recommend different types of trauma-focused psychotherapeutic treatments as first-line PTSD treatment. However, concerning pharmacological therapies recommendations are inconsistent. What are the main findings?

Response: Our network meta-analysis including 12 RCTs with 23 comparisons (922 participants) demonstrated very similar results of the three approaches at the end of treatment, but long-term effects of psychotherapeutic and combined treatments were superior to pharmacological treatments across 6 RCTs  (8 comparisons, 325 participants) reporting follow-up data. What should readers take away from your report?

Response: The available evidence is extremely sparse, and does not support the use of pharmacological PTSD treatments as first-line treatments if long-term improvements are intended.

Our results suggest superiority of psychotherapeutic and partly of combined treatments over pharmacological treatments in improving PTSD symptom severity in the long-term. What recommendations do you have for future research as a result of this work?

Response: Large-scaled comparative trials preferably including all three approaches (i.e., psychotherapeutic and pharmacological treatments and the combination of the two) reporting long-term outcomes are urgently needed. In view of the high placebo responses that are typically observed in pharmacological trials, a placebo control should also be included.

I have no disclosures.


Merz J, Schwarzer G, Gerger H. Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress DisorderA Network Meta-analysisJAMA Psychiatry. Published online June 12, 2019. doi:10.1001/jamapsychiatry.2019.0951



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