Escitalopram in the prevention of posttraumatic stress disorder: a pilot randomized controlled trial

BMC Psychiatry

Dan J Stein²  Joseph Zohar¹  Taryn Sutherland³  Janine Pingo³  Soraya Seedat³  Sharain Suliman³ 

[1] Department of Psychiatry, Tel-Aviv University, Tel-Aviv, Israel;MRC Anxiety Disorders Unit and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa;MRC Anxiety Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa

关键词: Randomised controlled trial;    Posttraumatic stress disorder;    Escitalopram;    Acute stress disorder;   

Others  :  1131645
DOI  :  10.1186/s12888-015-0391-3

 received in 2014-10-15, accepted in 2015-01-15,  发布年份 2015

【 摘 要 】

Background

A small literature suggests that pharmacotherapy may be useful in the prophylaxis of posttraumatic stress disorder in patients presenting with major trauma. There is relatively little data, however, on the use of selective serotonin reuptake inhibitors (SSRIs) in this context.

Methods

24 week, double-blind placebo controlled study. 31 participants presenting immediately after trauma, and meeting diagnostic criteria for full or partial acute stress disorder were randomized to treatment with 10–20 mg of escitalopram or placebo daily for 24 weeks. 2 participants were excluded from the analysis due to early drop out, leaving 29 participants (escitalopram = 12, placebo = 17) for inclusion in an intent- to- treat analysis. Participants were followed up until 56 weeks, and assessed with the Clinician Administered PTSD Scale (CAPS). A mixed model repeated measures analysis of variance (RMANOVA) was undertaken to determine the efficacy of the intervention on the CAPS score.

Results

There was a significant reduction in CAPS score over the course of treatment (F(7, 142) = 41. 58, p < 0.001) in both the escitalopram and placebo groups, with a greater reduction in CAPS score in the placebo group F(7, 142) = 2.12, p = 0.045. There were improvements on all secondary measures, including the Clinical Global Impressions scale, and scales assessing depression, anxiety and disability. Only functional disability outcomes (F(7, 141) = 2.13, p = .04), were significantly different between treatment and placebo groups. In the sample as a whole, improvement in scores were maintained at the 52 week follow-up. Side effects were comparable between the groups.

Conclusions

These data are consistent with other recent work indicating that the SSRIs may not be efficacious in the prevention of PTSD. Nevertheless, the small sample size and baseline differences between groups limit the explanatory power of the study. Although a consideration of the possibility of medication prophylaxis in PTSD remains important, both from conceptual and clinical perspectives, caution is needed with regards to the use of SSRIs until their efficacy can be proven.

Trial registration

Clinical Trials NCT00300313 webcite

【 授权许可】

   
2015 Suliman et al.; licensee BioMed Central.

【 图 表 】

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