AN OPEN TRIAL OF PAROXETINE IN PATIENTS WITH NONCOMBAT-RELATED, CHRONIC POSTTRAUMATIC-STRESS-DISORDER

The symptom overlap between posttraumatic stress disorder (PTSD) and o ther pharmacotherapy-responsive disorders suggests that pharmacotherap y might be effective. Nevertheless, of the eight published placebo-con trolled trials investigating the pharmacotherapy of PTSD, only four fo und statistically significant efficacy for the treatment being studied . This Literature possesses a number of methodologic limitations, incl uding the fact that most studies have been conducted with war veterans , who may constitute a more treatment-refractory population. Several o pen trials and one controlled trial with selective serotonin reuptake inhibitors have reported improvement in some or all core PTSD symptoms (reexperiencing, avoidance, numbing, and hyperarousal). The authors h ypothesized that paroxetine might be effective in PTSD, based on findi ngs of its particular efficacy for anxiety and agitation in studies of depressed patients. The study presented here summarizes a 12-week, op en-label trial of paroxetine among patients with noncombat-related, ch ronic PTSD. Outcome was assessed by an independent evaluator, the trea ting physician, and the patient, with the use of established rating sc ales for depression, anxiety, general symptoms, and PTSD core symptoms . A repeated-measures analysis of variance revealed highly significant improvement in all three symptom clusters, as well as in associated a nxiety, depressive, and dissociative symptoms, with 11 of 17 (65%) pat ients rated as much or very much improved. The mean reduction in PTSD symptom scores was 48%. Exploratory analyses revealed that cumulative childhood trauma was negatively correlated with pharmacotherapy respon se (r = -0.52, p = 0.03). There was also significant variation in the time course of response across symptom clusters, which is suggestive o f multiple mechanisms of response. Because paroxetine seems a highly p romising treatment for all three symptom clusters of PTSD, a placebo-c ontrolled clinical trial is warranted.