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Comparing Medications for DSM-5 PTSD in Routine VA Practice.
- Source :
-
The Journal of clinical psychiatry [J Clin Psychiatry] 2020 Oct 13; Vol. 81 (6). Date of Electronic Publication: 2020 Oct 13. - Publication Year :
- 2020
-
Abstract
- Objective: Fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine have previously shown efficacy for posttraumatic stress disorder (PTSD). One prior study using US Department of Veterans Affairs (VA) medical records data to compare these agents found no differences in symptom reduction in clinical practice. The current study addresses several weaknesses in that study, including limited standardization of treatment duration, inability to account for prior treatment receipt, use of an outdated symptomatic assessment for PTSD, and lack of functional outcome.<br />Methods: A total of 834 VA outpatients were identified with DSM-5 clinical diagnoses of PTSD between October 2016 and March 2018 who initiated one of the medications and met prespecified criteria for treatment duration and dose, combined with baseline and endpoint DSM-5 PTSD Checklist (PCL-5) measurements. Twelve-week acute-phase changes in PCL-5 score and remission of PTSD symptoms were compared among patients receiving the different medications, as was use of acute psychiatric services in the subsequent 6-month continuation phase.<br />Results: In the acute phase, patients improved by a mean of 6.8-10.1 points on the PCL-5 and 0.0%-10.9% achieved remission of PTSD symptoms. Those taking venlafaxine were significantly more likely to achieve remission (P = .008 vs fluoxetine and P < .0001 vs paroxetine, sertraline, and topiramate). In the continuation phase, there were no differences in acute psychiatric care use between medications. Those who continued their medication were less likely to use acute psychiatric services (HR = 0.55; P = .03).<br />Conclusions: There may be an advantage to venlafaxine over other agents in achieving acute-phase remission for DSM-5 PTSD in routine clinical practice, but this finding requires further study. Regardless of the agent chosen, medication cessation during the continuation phase is associated with a higher risk of acute psychiatric care use.<br /> (© Copyright 2020 Physicians Postgraduate Press, Inc.)
- Subjects :
- Acute Disease
Adult
Carbonic Anhydrase Inhibitors administration & dosage
Female
Fluoxetine administration & dosage
Humans
Male
Medication Adherence
Paroxetine administration & dosage
Remission Induction
Selective Serotonin Reuptake Inhibitors administration & dosage
Serotonin and Noradrenaline Reuptake Inhibitors administration & dosage
Sertraline administration & dosage
Topiramate administration & dosage
United States
United States Department of Veterans Affairs
Venlafaxine Hydrochloride administration & dosage
Carbonic Anhydrase Inhibitors pharmacology
Fluoxetine pharmacology
Outcome Assessment, Health Care
Paroxetine pharmacology
Selective Serotonin Reuptake Inhibitors pharmacology
Serotonin and Noradrenaline Reuptake Inhibitors pharmacology
Sertraline pharmacology
Stress Disorders, Post-Traumatic drug therapy
Topiramate pharmacology
Venlafaxine Hydrochloride pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1555-2101
- Volume :
- 81
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of clinical psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 33049805
- Full Text :
- https://doi.org/10.4088/JCP.20m13244