Department of Psychology, University of Zurich, Zurich, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland.
Transl Psychiatry. 2023 Jun 15;13(1):207. doi: 10.1038/s41398-023-02495-2.
Trauma-focused psychotherapy (tf-PT) is the first-line treatment for posttraumatic stress disorder (PTSD). Tf-PT focuses on processing and modulating trauma memories. Not all patients benefit, however, and there is room for improvement of efficacy. Pharmacologically augmenting trauma memory modulation in the context of tf-PT may help optimise treatment outcome. To systematically review effects of pharmacologically augmented memory modulation in the context of tf-PT for PTSD (PROSPERO preregistration ID: CRD42021230623). We conducted a systematic review of randomised controlled trials of psychotherapy treatment for PTSD. We included placebo-controlled studies that augmented at least one treatment session pharmacologically targeting memory extinction or reconsolidation. We calculated post-treatment between group (pharmacological augmentation vs placebo control) effect sizes of PTSD symptom severity. We included 13 RCTs. There was large heterogeneity in augmentation procedure and methodological quality. Four studies showed significantly greater PTSD symptom reduction in the pharmacological augmentation group (propranolol, hydrocortisone, dexamethasone, D-cycloserine) compared to placebo. Seven studies showed no significant effect of pharmacological augmentation compared to placebo (D-cycloserine, rapamycin, mifepristone, propranolol, mifepristone combined with D-cycloserine, methylene blue). Two studies showed significantly smaller PTSD symptom reduction in the pharmacological augmentation group (D-cycloserine, dexamethasone) compared to placebo. Results of pharmacological augmentation were mixed overall and heterogenous for the pharmacological agents tested in more than one study. Additional studies and replications are needed to identify which pharmacological agents work, in which combination and to identify patient groups that benefit most to tailor PTSD treatment.
创伤聚焦心理疗法（tf-PT）是创伤后应激障碍（PTSD）的一线治疗方法。tf-PT 侧重于处理和调节创伤记忆。然而，并非所有患者都从中受益，疗效仍有提升空间。在 tf-PT 的背景下，药理学增强创伤记忆调节可能有助于优化治疗效果。系统评价创伤聚焦心理疗法背景下药理学增强记忆调节治疗 PTSD 的效果（PROSPERO 预注册 ID：CRD42021230623）。我们对 PTSD 的心理治疗随机对照试验进行了系统评价。我们纳入了至少有一个治疗疗程通过药理学靶向记忆遗忘或再巩固来增强的安慰剂对照研究。我们计算了 PTSD 症状严重程度的治疗后组间（药理学增强与安慰剂对照）效应量。我们纳入了 13 项 RCT。增强程序和方法学质量存在很大异质性。四项研究显示，与安慰剂相比，药理学增强组 PTSD 症状显著减轻（普萘洛尔、氢化可的松、地塞米松、D-环丝氨酸）。七项研究显示，与安慰剂相比，药理学增强无显著效果（D-环丝氨酸、雷帕霉素、米非司酮、普萘洛尔、D-环丝氨酸联合米非司酮、亚甲蓝）。两项研究显示，与安慰剂相比，药理学增强组 PTSD 症状显著减轻（D-环丝氨酸、地塞米松）。总体而言，药理学增强的结果喜忧参半，而且对于多个研究中测试的药理学药物也存在异质性。需要更多的研究和复制来确定哪些药理学药物有效，哪些组合有效，以及确定最受益的患者群体，以定制 PTSD 治疗。
