Choice of treatment

The best treatment options of PTSD to date are cognitive-behavioural treatments and SSRIs. Effect sizes of these treatments are comparable. Psychological treatments have the advantage of lower drop-out rates. The meta-analysis found that, across studies, 14 per cent of the patients dropped out of psychological treatments, compared with 36 per cent for the SSRIs/99,) An additional advantage of cognitive-behavioural treatments is their established long-term effectiveness. Treatment gains are maintained during follow-up. (99,109) In contrast, long-term follow-up studies are lacking for pharmacological treatments, so that it is not known whether treatment-effects are maintained when medications are withdrawn or when they are continued for long periods. The advantage of SSRIs compared to cognitive-behavioural treatment is that they are more readily available.

Recent expert consensus guidelines concluded that cognitive-behavioural treatments are the treatment of choice for PTSD. For very severe or special cases (e.g. geriatric patients) the combination of these psychological treatments with pharmacotherapy is recommended as an alternative to psychological treatment alone.

Special considerations may apply to subgroups of PTSD patients. The efficacy of psychological treatments in patients with comorbid substance dependence remains to be established. It has been suggested that SSRIs are particularly useful for these patients, (1,08) but controlled trials are lacking.

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