National Center for PTSD, White River Junction VA Medical Center, 215 North Main, White River Junction, VT 05001, USA.
J Gen Intern Med. 2013 Jul;28 Suppl 2(Suppl 2):S542-8. doi: 10.1007/s11606-012-2260-9.
The Department of Veterans Affairs (VA) and Department of Defense (DoD) issued a revised posttraumatic stress disorder (PTSD) Clinical Practice Guideline (CPG) in 2010 with specific pharmacotherapy recommendations for evidence-based quality care. The authors examined prescribing frequencies over an 11-year period prior to the release of the new guideline to determine gender differences in pharmacotherapy treatment in veterans with PTSD.
National administrative VA data from 1999 to 2009 were used to identify veterans with PTSD using ICD-9 codes extracted from inpatient discharges and outpatient clinic visits. Prescribing of antidepressants, antipsychotics and hypnotics was determined for each year using prescription drug files.
Women were more likely than men to receive medication across all classes except prazosin where men had higher prescribing frequency. The proportion of women receiving either of the first-line pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI), increased from 56.4 % in 1999 to 65.7 % in 2009, higher rates than seen in men (49.2 % to 58.3 %). Atypical antipsychotic prescriptions increased from 14.6 % to 26.3 % and nonbenzodiazepine hypnotics increased from 3.8 % to 16.9 % for women, higher frequencies than seen in men for both medications (OR = 1.31, 1.43 respectively). The most notable gender discrepancy was observed for benzodiazepines where prescriptions decreased for men (36.7 % in 1999 to 29.8 % in 2009) but steadily increased for women from 33.4 % to 38.3 %.
A consistent pattern of increased prescribing of psychotropic medications among women with PTSD was seen compared to men. Prescribing frequency for benzodiazepines showed a marked gender difference with a steady increase for women despite guideline recommendations against use and a decrease for men. Common co-occurring disorders and sleep symptom management are important factors of PTSD pharmacotherapy and may contribute to gender differences seen in prescribing benzodiazepines in women but do not fully explain the apparent disparity.
退伍军人事务部（VA）和国防部于 2010 年发布了修订后的创伤后应激障碍（PTSD）临床实践指南（CPG），其中针对循证质量护理提出了具体的药物治疗建议。作者在新指南发布前的 11 年期间检查了处方频率，以确定 PTSD 退伍军人中药物治疗的性别差异。
使用从住院和门诊就诊中提取的 ICD-9 代码，从 1999 年至 2009 年的国家行政 VA 数据中确定 PTSD 退伍军人。使用处方药物档案确定每年抗抑郁药、抗精神病药和催眠药的处方情况。
女性比男性更有可能接受所有类别的药物治疗，除了哌唑嗪，男性的处方频率更高。接受 PTSD 的一线药物治疗（选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs））的女性比例从 1999 年的 56.4%增加到 2009 年的 65.7%，高于男性（49.2%至 58.3%）。非典型抗精神病药处方从 14.6%增加到 26.3%，非苯二氮䓬类催眠药从 3.8%增加到 16.9%，女性的用药频率均高于男性（OR=1.31，1.43）。最显著的性别差异发生在苯二氮䓬类药物上，男性的处方量减少（1999 年为 36.7%，2009 年为 29.8%），而女性则从 33.4%稳步增加到 38.3%。
与男性相比，PTSD 女性接受精神药物治疗的频率持续增加，呈现出一致的模式。尽管指南建议不要使用，但苯二氮䓬类药物的处方频率显示出明显的性别差异，女性持续增加，而男性则减少。常见共病和睡眠症状管理是 PTSD 药物治疗的重要因素，可能导致女性苯二氮䓬类药物处方的性别差异，但不能完全解释明显的差异。
