Nav: Home

Which is more effective for treating PTSD: Medication, or psychotherapy?

December 19, 2019

CHAPEL HILL, N.C. (December 19, 2019) - A new study that sought to find out whether serotonin reuptake inhibitors or trauma-focused psychotherapy is more effective in treating posttraumatic stress disorder (PTSD) concluded there is insufficient evidence at present to make that determination.

"Because of these findings, we recommend that, until we have evidence from head-to-head trials favoring one treatment or the other, clinicians should make shared decisions, with patients, about which treatment modality to use," said Jeffrey Sonis, MD, MPH, lead author of the study and an associate professor in the departments of social medicine and family medicine in the University of North Carolina School of Medicine. "These decisions should be based on patient preferences with regard to several treatment characteristics, such as the frequency of visits and time between treatment initiation and the onset of beneficial effects."

The systematic review and meta-analysis was led by Sonis and is published in the December 2019 issue of the journal Psychiatry Research. Joan M. Cook, PhD, of Yale University is co-author of the study.

Most guidelines for the treatment of PTSD in adults recommend that trauma-focused psychotherapy be used as a first-line treatment and medications be used as a second-line treatment, Sonis said. In other words, they recommend that psychotherapy should be offered, preferentially, to adults with PTSD, over medication. Those guidelines base those recommendations upon the fact that the effect sizes (the magnitude of the treatment effects) from randomized trials that compare psychotherapy to controls (such as wait-list controls) are substantially larger than the effect size from trials comparing medications to placebo.

However, comparing effect sizes based on indirect comparison is a flawed approach, Sonis said, because methodological differences between psychotherapy trials and medication trials are known to be associated with the effect size. For instance, blinding or masking, which is routine in medication trials but impossible in psychotherapy trials is known to be associated with smaller effect sizes. Other methodological differences are also associated with effect size and may explain the difference in effect sizes for psychotherapy and medication trials.

"We believe that only head-to-head randomized trials comparing psychotherapy directly to medications should be used to determine the relative effectiveness of psychotherapy and medications for treatment of PTSD," Sonis said. "There have been other meta-analyses of head-to-head randomize trials for treatment of PTSD previously but several head-to-head trials had been published since the last meta-analysis. Therefore, we conducted a meta-analysis exclusively consisting of head-to-head randomized trials."

"We found that the best estimate of the effect, comparing psychotherapy and medications, was that there was no difference between the two. However, the 95% confidence interval was very wide, indicating that true effect may favor psychotherapy or it may favor medications. We concluded that there is still insufficient evidence to determine whether psychotherapy or medications were more effective for treatment of PTSD in adults," Sonis said.

Until there is clear evidence from head-to-head trials favoring one treatment or the other, Sonis said, clinicians should make shared decisions, with patients, about which treatment modality to use, based not on comparative effectiveness (which is inconclusive) but on patient preferences regarding the following factors:
  • presumed mechanism of action

  • what is required of the patient

  • whether the patient will need to talk about the trauma frequency of visits

  • time between treatment initiation and onset of beneficial effects

  • duration of benefit after treatment cessation

  • risk and adverse effects
"The bottom line is that while many researchers and clinicians believe that psychotherapy is more effective for treatment of PTSD than medications, our research shows that there is -- as of right now -- insufficient evidence from head-to-head trials to make that determination at this time," Sonis said. "Therefore, the choice of medication or psychotherapy as the initial treatment should be based on patient preferences for treatment characteristics and not on incorrect assumptions about which treatment is more effective."

University of North Carolina Health Care

Related Ptsd Articles:

How building features impact veterans with PTSD
The built environment, where someone lives (private) or works (public), influences a person's daily life and can help, or hinder, their mental health.
Work-related PTSD in nurses
A recent Journal of Clinical Nursing analysis of published studies examined the prevalence of post-traumatic stress disorder (PTSD) among nurses and identified factors associated with work-related PTSD among nurses.
PTSD and moral injury linked to pregnancy complications
Elevated symptoms of PTSD and moral injury can lead to pregnancy complications, found a Veterans Affairs study of women military veterans.
Early treatment for PTSD after a disaster has lasting effects
In 1988, a 6.9 magnitude earthquake struck near the northern Armenian city of Spitak.
Cyberbullying Linked to Increased Depression and PTSD
Cyberbullying had the impact of amplifying symptoms of depression and post-traumatic stress disorder in young people who were inpatients at an adolescent psychiatric hospital, according to a new study published in the Journal of Clinical Psychiatry.
Psychedelic drugs could help treat PTSD
Clinical trials suggest treatment that involves psychedelics can be more effective than psychotherapy alone.
Which is more effective for treating PTSD: Medication, or psychotherapy?
A systematic review and meta-analysis led by Jeffrey Sonis, MD, MPH, of the University of North Carolina School of Medicine, finds there is insufficient evidence at present to answer that question.
Cannabis could help alleviate depression and suicidality among people with PTSD
Cannabis may be helping Canadians cope with the effects of post-traumatic stress disorder (PTSD), new research suggests.
BU finds PTSD nearly doubles infection risk
A new Boston University School of Public Health (BUSPH) study is the first to examine the relationship between post-traumatic stress disorder (PTSD) and dozens of infection types in a nationwide cohort.
PTSD linked to increased risk of ovarian cancer
Women who experienced six or more symptoms of post-traumatic stress disorder (PTSD) at some point in life had a twofold greater risk of developing ovarian cancer compared with women who never had any PTSD symptoms, according to a new study from researchers at Harvard T.H.
More PTSD News and PTSD Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at