Double-Blind?

Baselineb and Change in PTSD Measure

Statistically Significant? (versus control)

Loss of Diagnosis or Clinical Improvement (%)

Principal Limitations

Yes

~30

 

N/A

Dropout 43% and 33%; handling of missing data unclear

 

−4.3

No

 

 

−1.2

 

provided, or by subtracting data reported at treatment completion (not follow-up data) from baseline data (before treatment began). Average baseline score when reported or when baseline scores for all arms are nearly the same; otherwise, baseline scores listed individually in order of arm.

Conclusion: The committee concludes that the evidence is inadequate to determine the efficacy of the MAOIs phenelzine and brofaromine in the treatment of PTSD.

Exclusion Notes

There are several open-label trials or trials in MAOIs with no comparison group, none of which were included (Davidson et al., 1987; Lerer et al., 1987; Neal et al., 1997). There was one head-to-head study comparing moclobemide and tianeptine. The efficacy of either of these drugs has not been proven, so this trial was excluded from the committee’s review. See Table 3-5 for a summary of the four included clinical trials.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

The committee found that the literature on SSRIs was the most extensive for any of the pharmacotherapies, identifying 14 studies meeting inclusion criteria (Brady et al., 2000; Connor et al., 1999; Davidson et al., 2001a, 2006b; Friedman et al., 2007; Hertzberg et al., 2000; Marshall et al., 2001, 2007; Martenyi et al., 2002a; Tucker et al., 2001, 2003; van der Kolk et al., 1994, 2007; Zohar et al., 2002). The studies examined different drugs (sertraline, fluoxetine, paroxetine, and citalopram) and dosage regimens for varying periods of time and differed in dropout rates (which were generally in the range of 30 percent), and many studies handled missing values with LOCF or conducted the analysis only on those completing treatment.

Participants in the SSRI studies had suffered a variety of traumas including combat-related (U.S. and international participants), sexual and



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