Psychotropic Medication May Reduce Symptoms and Improve Functioning in PTSD
In patients with traumatic injury, there may be a benefit to starting paroxetine to prevent PTSD and associated symptoms, including numbing and avoidance.
According to study results published in the Journal of Orthopaedic Trauma, early treatment of posttraumatic stress disorder (PTSD) using paroxetine therapy may prevent or mitigate the emergence of PTSD and depressive symptoms and even improve general health and functioning.
The investigators of this double-blind, randomized, placebo-controlled study sought to determine whether early pharmacologic intervention with psychotropic medication can prevent or reduce PTSD symptoms, including major depressive symptoms, and improve the level of social and musculoskeletal functioning in injured trauma survivors.
The study sample included 120 patients admitted for traumatic orthopedic injury to the Parkland Memorial Hospital Trauma Service in Texas over a 3-year period. Participants began treatment with either paroxetine (n=60) or placebo (n=60) 2 weeks after their injury and were assessed at week 4 (baseline), week 6, month 3, month 6, and month 12. Primary outcome measures included the presence and severity of PTSD and major depressive symptoms, which were measured using the PTSD Checklist and the Quick Inventory of Depressive Symptomology (QIDS), respectively. General health and social functioning post-injury were assessed at each time point using the Short Form Health Survey (SF-36); musculoskeletal functioning was rated according to the Short Musculoskeletal Functional Assessment (SMFA).
The investigators found that PTSD was assessed in comparable proportions in both the paroxetine and the placebo groups at the 6- and 12-month time points. The investigators also observed a comparable proportion of patients with major depression symptoms in both groups 3 months post-injury. At the 8-week follow-up, change in QIDS scores from baseline did not differ between the 2 study groups. However, compared to the placebo group, paroxetine users showed significantly better SF-36 functioning scores from baseline to the 12-month follow-up, as well as a marginally greater reduction in SMFA musculoskeletal functioning problems.
Limitations of the study included a small sample size and incomplete follow-up data.
The investigators suggest that psychotropic medications have the potential to prevent or reduce PTSD and depression in trauma patients and possibly improve their general health and functional recovery. Future studies should further explore the role of paroxetine for effectively treating patients with PTSD.
Borrelli J Jr, Star A, Downs DL, North CS. A prospective study of the effectiveness of paroxetine on the onset of posttraumatic stress disorder, depression, and health and functional outcomes after trauma [published online September 10, 2018]. J Orthop Trauma. doi:10.1097/BOT.0000000000001342