Comparative Effectiveness of Psychotropic Medications for PTSD in Clinical Practice
Abstract
People exposed to severe trauma sometimes develop persistent and bothersome symptoms called post-traumatic stress disorder. These symptoms include re-experiencing the trauma in the form of flashbacks and nightmares, avoiding reminders of the trauma, problems with their mood and memory of the trauma, and experiencing hyperarousal symptoms such as heart palpitations, sweating, anger, and being “on guard.” As military Service members are commonly exposed to traumatic situations inside and outside of combat, they are at risk of developing post-traumatic stress disorder. Post-traumatic stress disorder can develop before, during, or after military service, and some Veterans continue to suffer many years after their discharge. Historically, about 12% of Veterans who use the Department of Veterans Affairs (VA) have post-traumatic stress. Fortunately, there are treatments for post-traumatic stress disorder, including medications and psychotherapy. There are several ways to test whether a medication is helpful for post-traumatic stress disorder. The most accepted way is to test whether a medication is better than a “placebo” (a sugar pill) using a randomized controlled trial. In a randomized controlled trial of a medication for post-traumatic stress disorder, neither the patients nor their doctors know who gets the placebo and who gets the medication. By keeping everything else the same, researchers can say whether any improvements in post-traumatic stress disorder are due to the medication. Using randomized controlled trials, researchers have identified five medications that consistently appear to work the best for post-traumatic stress disorder: Zoloft® (sertraline), Paxil® (paroxetine), Prozac® (fluoxetine), Effexor® (venlafaxine), and Topamax® (topirimate). However, there are a few problems in understanding whether these results apply to Veterans with post-traumatic stress disorder. First, in order to focus specifically on post-traumatic stress disorder, randomized controlled trials often exclude patients with other problems that are common among Veterans, such as substance abuse. Second, many randomized controlled trials of medications for post-traumatic stress disorder have not included Veterans, and those that included Veterans had less impressive results. Third, randomized controlled trials for post-traumatic stress disorder often prevent patients from also receiving psychotherapy, whereas many Veterans receive both medication and psychotherapy when treated in the VA. Finally, randomized controlled trials do not indicate which medications are the best for important groups of Veterans with post-traumatic stress disorder who may respond differently to treatments. These groups can be defined by demographics (women are an example), military exposures (sexual trauma is an example), and other medical problems (pain is an example). One way to answer questions about which medications for post-traumatic stress work for the best for Veterans who use the VA would be to conduct a large clinical trial comparing all five of the medications. While this would be an important study, it would be very expensive, take many years, and might be a lot to ask of Veterans. Another way would be to learn from Veterans’ experience receiving these treatments in the VA as part of routine practice. All five of these medications have been available and regularly prescribed in the VA for over 15 years. The VA has a national data warehouse containing information from electronic medical records used in routine practice. This includes information on visits, diagnoses, prescriptions, and symptoms. This proposal would use VA data to determine which of the five medications decreases symptoms and use of psychiatric emergency services the most. This proposal also has an exploratory aim to determine whether specific groups of Veterans do better on specific medications for post-traumatic stress disorder and whether any of the medications work
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710572
Entities
People
- Brian Shiner
Organizations
- United States Army
- Veterans Education and Research Association of Northern New England