Sertraline treatment of posttraumatic stress disorder: Results of 24 weeksof open-label continuation treatment

Background: Posttraumatic stress disorder (PTSD) is typically associated wi th a high degree of chronicity, comorbidity, and psychosocial disability. T he efficacy of sertraline in the acute treatment of PTSD has been confirmed based on the results of 2 large, placebo-controlled studies, but almost no prospective long-term treatment studies have been reported. Method: One hundred twenty-eight patients who completed 12 weeks of double- blind, placebo-controlled, acute-phase treatment for DSM-III-R-defined PTSD with sertraline were continued into a 24-week open-label continuation phas e. Efficacy was evaluated using the endpoint change in the 17-item Clinicia n Administered PTSD Scale Part 2 (CAPS-2) severity score, the 15-item patie nt-rated Impact of Event Scale, and the Clinical Global Impressions-Improve ment and -Severity of Illness scales as primary outcome measures. Treatment response was defined as greater than or equal to 30% decrease in the CAPS- 2 total severity score (compared with acute-phase baseline score) and a Cli nical Global Impressions-Improvement score of 1 or 2, Results: Ninety-two percent of acute-phase responders maintained their resp onse during the full 6 months of continuation treatment. In addition, 54% o f acute-phase nonresponders converted to responder status during continuati on therapy. Over the 36-week course of acute and continuation therapy, 20% to 25% of the improvement in the CAPS-2 severity score occurred during the continuation phase. Sertraline was well tolerated, with 8.6% of patients di scontinuing due to adverse events. A high pretreatment CAPS-2 score (> 75) predicted a longer time to response and a greater likelihood that response occurred after 12 weeks of acute treatment. Conclusion: The acute efficacy of sertraline is sustained in the vast major ity of patients, and at least half of nonresponders to acute treatment will eventually respond to continued treatment.