Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial

Details

• Personal Author:
  Amsel L ; Hembree E ; Marshall RD ; Neria Y ; Pavlicova M ; Schneier FR ; Suh EJ
• Description:
  Objective: Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD. Method: Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment. Results: Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences. Conclusions: Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods. [Description provided by NIOSH]
• Subjects:
  Delivery Of Health Care Health Care Facilities Workforce And Services Men Mental Health Occupational Health Risk Assessment Risk Factors Safety Stress, Psychological Women
• Keywords:
  Humans Medical-care Medical-monitoring Medical-treatment Medicinal-chemicals Mental-health Mental-stress Psychological-effects Psychological-reactions Psychological-stress Psychology Risk-factors

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• ISSN:
  0002-953X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  80-88
• Volume:
  169
• Issue:
  1
• NIOSHTIC Number:
  nn:20046555
• Citation:
  Am J Psychiatry 2012 Jan; 169(1):80-88
• Contact Point Address:
  Franklin R. Schneier, M.D., Trauma and Post Traumatic Stress Disorder Program, Anxiety Disorders Clinic, New York State Psychiatric Institute, New York; Departments of Psychiatry and Biostatistics, Columbia University, New York
• Email:
  frs1@columbia.edu
• Federal Fiscal Year:
  2012
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  The American Journal of Psychiatry
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2ef2f3b687c485373301f7be246e930b249b6fe15c9078b518346e124117207eac0ee1b11e2ce8754596bd62eb90999c4e30294ae4c11c3590aa984fb7c02afd
• Download URL:
  https://stacks.cdc.gov/view/cdc/201570/cdc_201570_DS1.pdf
• File Type:
  [PDF - 331.05 KB ]