Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression

A systematic review and meta-regression analysis

Timothy W. Puetz, Shawn Youngstedt, Matthew P. Herring

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

The efficacy of pharmacotherapy for PTSD, anxiety, and depression among combat veterans is not well-established. Objectives: To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. Materials and Methods: Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. Results: Pharmacotherapy significantly reduced (Δ, 95%CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. Conclusions: Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.

Original languageEnglish (US)
Article numbere0126529
JournalPLoS One
Volume10
Issue number5
DOIs
StatePublished - May 28 2015

Fingerprint

Drug therapy
systematic review
anxiety
Post-Traumatic Stress Disorders
Regression analysis
Meta-Analysis
regression analysis
Anxiety
Regression Analysis
Depression
Drug Therapy
Tricyclic Antidepressive Agents
Veterans
antidepressants
drug therapy
signs and symptoms (animals and humans)
Moderators
Selection Bias
Sampling
placebos

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression : A systematic review and meta-regression analysis. / Puetz, Timothy W.; Youngstedt, Shawn; Herring, Matthew P.

In: PLoS One, Vol. 10, No. 5, e0126529, 28.05.2015.

Research output: Contribution to journalArticle

@article{d6130366756141809d5ac6170f50a7c2,
title = "Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression: A systematic review and meta-regression analysis",
abstract = "The efficacy of pharmacotherapy for PTSD, anxiety, and depression among combat veterans is not well-established. Objectives: To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. Materials and Methods: Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. Results: Pharmacotherapy significantly reduced (Δ, 95{\%}CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. Conclusions: Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.",
author = "Puetz, {Timothy W.} and Shawn Youngstedt and Herring, {Matthew P.}",
year = "2015",
month = "5",
day = "28",
doi = "10.1371/journal.pone.0126529",
language = "English (US)",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

}

TY - JOUR

T1 - Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression

T2 - A systematic review and meta-regression analysis

AU - Puetz, Timothy W.

AU - Youngstedt, Shawn

AU - Herring, Matthew P.

PY - 2015/5/28

Y1 - 2015/5/28

N2 - The efficacy of pharmacotherapy for PTSD, anxiety, and depression among combat veterans is not well-established. Objectives: To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. Materials and Methods: Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. Results: Pharmacotherapy significantly reduced (Δ, 95%CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. Conclusions: Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.

AB - The efficacy of pharmacotherapy for PTSD, anxiety, and depression among combat veterans is not well-established. Objectives: To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. Materials and Methods: Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. Results: Pharmacotherapy significantly reduced (Δ, 95%CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. Conclusions: Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.

UR - http://www.scopus.com/inward/record.url?scp=84934989780&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84934989780&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0126529

DO - 10.1371/journal.pone.0126529

M3 - Article

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 5

M1 - e0126529

ER -