Cognitive and Prolonged Exposure Therapies Beat SSRI for Early PTSD


BARCELONA — When given within a month of the precipitating event, cognitive therapy and prolonged exposure therapy are equally effective at decreasing the incidence of posttraumatic stress disorder—and both strategies are significantly more effective than treatment with escitalopram, study results showed.

The drug was no better than placebo or no treatment at all, a finding that disappointed Dr. Arieh Y. Shalev. “I'm saddened by it,” he said at the annual congress of the European College of Neuropsychopharmacology. “We wanted this to have a positive effect, because we thought, in the case of mass trauma, it would be very good to have a compound that could be distributed soon after the event.”

Dr. Shalev, director and founder of the Center for Traumatic Stress at Hadassah University Hospital, Jerusalem, presented the results of a randomized controlled trial of early intervention for posttraumatic stress disorder (PTSD). The potential study group consisted of 5,285 survivors of a traumatic event, who were all identified by emergency room records. All the subjects were contacted by telephone within a few days of discharge.

Most of the traumatic events (75%) involved a motor vehicle accident, 14% were work related, and 4% were terrorist events.

Researchers invited 1,470 survivors who expressed some PTSD symptoms to a clinical assessment. Almost half (49%) declined this invitation right away, Dr. Shalev said, indicating an enormous cultural barrier to seeking PTSD treatment.

Of those who were assessed, 398 had qualifying symptoms; 298 of those subjects were randomized into the trial, with treatment beginning within 20 days of the traumatic event. Treatment arms included 12 weekly sessions of cognitive therapy, 12 weekly sessions of prolonged exposure, 12 weeks of blinded treatment with placebo or 20 mg of the SSRI escitalopram (Lexapro), or 12 weeks on a waiting list. The group on the waiting list received only weekly telephone calls to check on their well-being and respond to emergencies.

All groups showed significantly reduced rates of PTSD. Cognitive therapy and prolonged exposure had the lowest incidence of PTSD (18% and 21%, respectively). Although escitalopram reduced the incidence of PTSD to 61%, it was not any more effective than placebo or being placed on the waiting list; the incidence of PTSD was reduced to 59% with placebo and to 57% for those on the waiting list.

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