Stein Dan J, Ipser Jonathan, McAnda Nicole
Department of Psychiatry and Mental Health, University of Cape Town.
CNS Spectr. 2009 Jan;14(1 Suppl 1):25-31.
A number of randomized controlled trials of the pharmacotherapy of posttraumatic stress disorder (PTSD) are now available. Several meta-analyses of these trials, and a number of consensus guidelines on the treatment of PTSD, have been published. Assessment of these meta-analyses and guidelines provides an opportunity to review the strengths and weaknesses of the evidence-base.
Meta-analyses of PTSD trials were assessed with the quality of reporting of meta-analyses (QUOROM) statement and the Oxman and Guyatt rating scale, and consensus statements on the treatment of PTSD were assessed with the Appraisal of Guidelines Research and Evaluation instrument. Summary statistics of meta-analyses and conclusions of guidelines were tabulated.
The quality of PTSD meta-analyses and guidelines is generally acceptable. Many consensus guidelines have emphasized the value of pharmacotherapy for PTSD. Consensus statements have, however, used different approaches, and their conclusions have differed. Many important questions for the field have not yet been adequately researched.
There have been significant advances in the pharmacotherapy of PTSD, and certain medications (eg, selective serotonin reuptake inhibitors) are appropriately viewed as a first-line treatment for adult PTSD. Nevertheless, as is the case in other anxiety disorders, there is a paucity of longer-term trials, data on treatment effectiveness in wider clinical practice, and data on treatment-resistant patients.
目前已有多项关于创伤后应激障碍（PTSD）药物治疗的随机对照试验。针对这些试验的多项荟萃分析以及一些关于PTSD治疗的共识指南已发表。对这些荟萃分析和指南进行评估，为审视证据基础的优缺点提供了契机。
采用荟萃分析报告质量（QUOROM）声明和奥克斯曼与盖亚特评分量表对PTSD试验的荟萃分析进行评估，并用指南研究与评价工具对PTSD治疗的共识声明进行评估。将荟萃分析的汇总统计数据和指南结论制成表格。
PTSD荟萃分析和指南的质量总体上是可以接受的。许多共识指南都强调了药物治疗对PTSD的价值。然而，共识声明采用了不同的方法，其结论也有所不同。该领域的许多重要问题尚未得到充分研究。
PTSD的药物治疗已取得显著进展，某些药物（如选择性5-羟色胺再摄取抑制剂）被恰当地视为成人PTSD的一线治疗药物。然而，与其他焦虑症一样，长期试验较少，缺乏更广泛临床实践中的治疗效果数据以及难治性患者的数据。
