Meta-analyses using long-term data suggest the superiority of psychotherapeutic treatments over pharmacologic treatments for adults with posttraumatic stress disorder (PTSD), according to study results published in JAMA Psychiatry.

Investigators searched Embase, MEDLINE, PsycINFO, Cochrane Controlled Trials Register, and PSYNDEX for studies, guidelines, and systematic reviews that compared the benefits of psychotherapeutic and pharmacologic treatments or their combinations for PTSD symptom improvement. They used pairwise and network meta-analyses, which allowed for both direct and indirect comparisons.

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Investigators identified 12 randomized controlled trials (RCTs) that involved a total of 922 participants and 23 direct comparisons. No treatment was superior to the others immediately after treatment completion. However, in studies that reported long-term follow-up data, psychotherapeutic treatments resulted in better PTSD symptom improvement than pharmacologic treatments in both pairwise (standardized mean differences [SMD]: −0.63; 95% CI: −1.18 to −0.09) and network (SMD: −0.83; 95% CI: −1.59 to −0.07) meta-analyses, and no difference was found between combined treatments and psychotherapeutic treatments. In the network meta-analysis, combined treatments resulted in better outcomes compared with pharmacologic treatments (SMD: −0.96; 95% CI: −1.87 to −0.04), but this was not the case in the pairwise meta-analysis.

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“Based on a comprehensive aggregation of all available direct comparisons, our results suggest clinically significant inferiority of pharmacological monotherapies in the long term,” investigators wrote. They added, “The scarcity of reported long-term findings hampers definite conclusions and demonstrates the need for robust evidence from large-scaled comparative trials providing long-term follow-up data.”


Merz J, Schwarzer G, Gerger H. Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis [published June 12, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0951