Jia Yanyan, Ye Zifeng, Yang Fude, Chai Jiabao, Xu Haiting, Yang Jingming, Liang Weiye, Wu Lili
Beijing Huilongguan Hospital, Peking University, Beijing, China.
Department of Medical Psychology of Hainan Hospital, Chinese PLA General Hospital, Sanya, China.
Ther Adv Psychopharmacol. 2025 Jun 14;15:20451253251342628. doi: 10.1177/20451253251342628. eCollection 2025.
Post-traumatic stress disorder (PTSD) is a prevalent mental illness with a high disability rate. The neurobiological abnormalities in PTSD suggest that drug therapy may have certain therapeutic effects. According to the recommendations of clinical guidelines for PTSD, the current clinical preference is for selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Nevertheless, the efficacy of other types of drugs remains uncertain, which impacts the selection of personalized treatment for patients.
The aim of this meta-analysis was to assess the efficacy and acceptability of drugs with different pharmacological mechanisms in alleviating PTSD symptoms by comparing the response rates and dropout rates of different drug treatment groups in randomized clinical trials.
Systematic review and meta-analysis.
We searched and analyzed 52 reports that described the efficacy and acceptability of medication for PTSD. Among these, 49 trials used the dropout rate as an acceptability indicator, and 52 trials used the response rate as an efficacy indicator.
In the 49 trials with the dropout rate as the indicator, the dropout rate was 29% (95% confidence interval, 0.26-0.33; = 3870). In the 52 trials with the response rate as the indicator, the response rate was 39% (95% confidence interval, 0.33-0.45; = 3808). After drug treatment, the core symptoms of PTSD were significantly improved. This meta-analysis indicated that there was no significant difference between antidepressants and antipsychotics in improving clinical symptoms and acceptability. However, antidepressants may have a slight advantage in efficacy, although with a higher dropout rate.
Drug treatment is an effective rehabilitation method for PTSD patients, and individualized drug management should be considered.
This systematic evaluation scheme has been registered with PROSPERO (protocol ID: CRD42023462662).
创伤后应激障碍（PTSD）是一种常见的精神疾病，致残率高。PTSD的神经生物学异常表明药物治疗可能有一定疗效。根据PTSD临床指南的建议，目前临床首选选择性5-羟色胺再摄取抑制剂（SSRIs）或5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）。然而，其他类型药物的疗效仍不确定，这影响了患者个性化治疗的选择。
本荟萃分析的目的是通过比较随机临床试验中不同药物治疗组的缓解率和脱落率，评估具有不同药理机制的药物在缓解PTSD症状方面的疗效和可接受性。
系统评价和荟萃分析。
我们检索并分析了52篇描述PTSD药物疗效和可接受性的报告。其中，49项试验将脱落率作为可接受性指标，52项试验将缓解率作为疗效指标。
在以脱落率为指标的49项试验中，脱落率为29%（95%置信区间，0.26 - 0.33；n = 3870）。在以缓解率为指标的52项试验中，缓解率为39%（95%置信区间，0.33 - 0.45；n = 3808）。药物治疗后，PTSD的核心症状明显改善。该荟萃分析表明，抗抑郁药和抗精神病药在改善临床症状和可接受性方面无显著差异。然而，抗抑郁药在疗效上可能有轻微优势，尽管脱落率较高。
药物治疗是PTSD患者有效的康复方法，应考虑个体化药物管理。
本系统评价方案已在国际前瞻性系统评价注册库（PROSPERO）注册（方案识别号：CRD42023462662）。
