Stein D J, Ipser J C, Seedat S
University of Cape Town, Dept of Psychiatry, Anzio Road, Rondebosch, Cape Town, South Africa, 7700.
Cochrane Database Syst Rev. 2006 Jan 25;2006(1):CD002795. doi: 10.1002/14651858.CD002795.pub2.
Post traumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment.
To assess the effects of medication for post traumatic stress disorder.
We searched the Cochrane Depression, Anxiety and Neurosis Group specialised register (CCDANCTR-Studies) on 18 August 2005, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 4, 2004), MEDLINE (January 1966 to December 2004), PsycINFO (1966 to 2004), and the National PTSD Center Pilots database. Reference lists of retrieved articles were searched for additional studies.
All randomised controlled trials (RCTs) of pharmacotherapy for PTSD.
Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken.
35 short-term (14 weeks or less) RCTs were included in the analysis (4597 participants). Symptom severity for 17 trials was significantly reduced in the medication groups, relative to placebo (weighted mean difference -5.76, 95% confidence intervals (CI) -8.16 to -3.36, number of participants (N) = 2507). Similarly, summary statistics for responder status from 13 trials demonstrated overall superiority of a variety of medication agents to placebo (relative risk 1.49, 95% CI 1.28 to 1.73, number needed to treat = 4.85, 95% CI 3.85 to 6.25, N = 1272). Medication and placebo response occurred in 59.1% (N = 644) and 38.5% (628) of patients, respectively. Of the medication classes, evidence of treatment efficacy was most convincing for the SSRIs. Medication was superior to placebo in reducing the severity of PTSD symptom clusters, comorbid depression and disability. Medication was also less well tolerated than placebo. A narrative review of 3 maintenance trials suggested that long term medication may be required in treating PTSD.
AUTHORS' CONCLUSIONS: Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability. The findings of this review support the status of SSRIs as first line agents in the pharmacotherapy of PTSD, as well as their value in long-term treatment. However, there remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.
创伤后应激障碍（PTSD）是一种常见且致残的疾病。有证据表明，PTSD具有特定的心理生物学功能障碍，这使得人们对使用药物治疗该疾病的兴趣日益浓厚。
评估药物治疗创伤后应激障碍的效果。
我们于2005年8月18日检索了Cochrane抑郁、焦虑与神经症小组专业注册库（CCDANCTR-Studies）、Cochrane对照试验中央注册库（CENTRAL）（2004年第4期《Cochrane图书馆》）、MEDLINE（1966年1月至2004年12月）、PsycINFO（1966年至2004年）以及国家创伤后应激障碍中心试验数据库。对检索到的文章的参考文献列表进行检索以寻找其他研究。
所有创伤后应激障碍药物治疗的随机对照试验（RCT）。
两名评价者独立评估RCT以纳入本综述，整理试验数据并评估试验质量。与研究者联系以获取缺失数据。汇总统计按药物类别分层，对于选择性5-羟色胺再摄取抑制剂（SSRI）则按药物制剂分层。使用随机效应模型计算二分法和连续性测量指标，评估异质性，并进行亚组/敏感性分析。
分析纳入了35项短期（14周或更短时间）RCT（4597名参与者）。相对于安慰剂，17项试验中药物治疗组的症状严重程度显著降低（加权平均差-5.76，95%置信区间（CI）-8.16至-3.36，参与者数量（N）=2507）。同样，13项试验中反应者状态的汇总统计表明，多种药物制剂总体上优于安慰剂（相对风险1.49，95%CI 1.28至1.73，需治疗人数=4.85，95%CI 3.85至6.25，N =1272）。药物治疗组和安慰剂组的反应率分别为59.1%（N =644）和38.5%（628）。在各类药物中，SSRI的治疗效果证据最具说服力。药物在降低PTSD症状群的严重程度、共病抑郁和残疾方面优于安慰剂。药物的耐受性也比安慰剂差。对3项维持治疗试验的叙述性综述表明，治疗PTSD可能需要长期用药。
药物治疗可有效治疗PTSD，能减轻其核心症状以及相关的抑郁和残疾。本综述的结果支持SSRI作为PTSD药物治疗一线药物的地位及其在长期治疗中的价值。然而，证据基础仍存在重要差距，在PTSD管理中持续需要更有效的药物。
