Posttraumatic stress disorder (PTSD) is easy to miss and difficult to live with. Despite being the fifth most common psychiatric disorder, it is correctly diagnosed less than 20% of the time. And, left untreated, its symptoms can last a lifetime. The good news is that effective treatments for PTSD do exist. Both selective serotonin reuptake inhibitors and cognitive-behavioral therapy (CBT) are effective, and therapy that combines the two shows particular promise.
Researchers delivered that message to participating psychiatrists and medical directors at the Behavioral Healthcare and Informatics Tomorrow conference, held Sept. 22-25, 2002, in Washington, D.C. The two speakers, Duke University psychiatrist Jonathan Davidson, M.D., and University of Pennsylvania psychologist Edna Foa, Ph.D., are working together on a study that compares medication-only and combined treatment for patients with PTSD.
Recent studies, according to Davidson, have found that as few as 4% of PTSD cases are picked up in either academic or community health centers (Davidson, 2001).
But psychiatrists do have some room for error. Pharmacotherapy with an SSRI is widely accepted as first-line treatment for PTSD. So if a psychiatrist misdiagnoses the disorder as depression or anxiety and chooses to treat it with an SSRI, the patient's symptoms will likely improve. According to Davidson, however, PTSD requires longer-term treatment at lower dosage levels than is often the case with other disorders.
Numerous studies have found that SSRIs can quickly reduce the intensity of affective symptoms, memories and impulsive behavior while also reducing excessive inhibitions. The U.S. Food and Drug Administration approved sertraline (Zoloft) for treatment of PTSD in 1999 and paroxetine (Paxil) in 2001.
Drugs alone can be effective, but they may work even better when combined with CBT, Davidson said. Either way, treatment must be individualized and long-term.
For psychosocial treatment, correctly diagnosing PTSD is a more critical issue, Foa said. Patients with PTSD who receive psychotherapy tailored to treat the wrong disorder are not likely to get the most benefit.
References
1.
Davidson JRT (2001), Recognition and treatment of posttraumatic stress disorder. JAMA 286(5):584-587.
2.
Davidson JR, Hughes D, Blazer DG, George LK (1991), Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21(3):713-721.
3.
Davidson J, Pearlstein T, Londborg P et al. (2001), Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study. Am J Psychiatry 158(12):1974-1981 [see comments].
4.
Foa EB, Dancu CV, Hembree EA et al. (1999), A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol 67(2):194-200.
5.
Foa EB, Street GP (2001), Women and traumatic events. J Clin Psychiatry 62(suppl 17):29-34.
6.
Kessler RC (2000), Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61(suppl 5):4-12.
