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Not too many good effects of anti-psychotic drugs

No Evidence that Psychiatric Drugs Work for PTSD

Thursday, April 24, 2008 by: David Gutierrez

There is no evidence that drug treatments or the majority of non-drug treatments work on post-traumatic stress disorder (PTSD), according to a major review of the medical literature on the topic.

A committee of the Institute of Medicine reviewed the literature on PTSD treatments upon the request of the U.S. Department of Veterans Affairs. Initially, the committee identified 2,771 studies, but eventually reviewed only 90 of these. The trials reviewed included randomized controlled trials, controlled psychotherapy trials and placebo-controlled pharmacotherapy trials.

Of the 90 studies, exposure therapy was the only treatment that was supported by evidence of its effectiveness. All other tested treatments had insufficient evidence to support them.

"These therapies may or may not be effective - we just don't know in the absence of good data," said committee chair Alfred O. Berg.

The researchers noted that they do not "intend to imply that ... exposure therapy is the only treatment that should be used in treating individuals with PTSD."

The pharmaceutical products tested included anticonvulsants; selective serotonin reuptake inhibitors and other antidepressants; prazosin (Minipress); the atypical antipsychotics olanzapine (Zyprexa) and risperidone (Risperdal); the monoamine oxidase inhibitors phenelzine (Nardil) and brofaromine (Consonar) naltrexone (Depade); cycloserine (Seromycin) and or inositol. The forms of psychotherapy tested included cognitive restructuring, coping skills training, eye movement desensitization and reprocessing, and group format psychotherapy.

The Institute of Medicine committee discarded the findings from many of the 90 studies due to flawed methodologies, too-high dropout rates (20 to 50 percent), or potential conflicts of interest. In addition, many of the studies failed to separate out the effects of other factors such as brain injury, depression or substance abuse.

According to J. Alexander Bodkin, a psychiatrist not involved in the study, it may be particularly difficult to establish the effectiveness of PTSD treatments because the symptoms of PTSD overlap significantly with those of other disorders.

"Apart from the event to which they are attributed, the symptoms [of PTSD] are remarkably generic manifestations of mood," Bodkin said.


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