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December 5, 2018

Use of Prolonged Exposure and Sertraline in the Treatment of Posttraumatic Stress Disorder for Veterans

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
  • 2Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
JAMA Psychiatry. 2019;76(2):109-110. doi:10.1001/jamapsychiatry.2018.3410

For deployed veterans from the wars in Iraq and Afghanistan, the estimated costs of posttraumatic stress disorder (PTSD) and depression were between $4.0 billion and $6.2 billion in the first 2 years after they returned home.1 A number of efficacious treatments for PTSD exist, including pharmacotherapy and psychotherapies, although the gap between those who could benefit from evidence-based treatment and those who receive it remains large. Across populations, selective serotonin reuptake inhibitors (SSRIs), such as sertraline, have demonstrated moderate effects, while exposure-based therapies, such as prolonged exposure (PE), show large effects.2 Accordingly, guidelines from the Veterans Administration and Department of Defense recommended sertraline as monotherapy for PTSD treatment among those who cannot or choose not to engage in trauma-focused therapy, such as PE.3 Given the enhanced effects of psychotherapy combined with medications for the treatment of depression and anxiety,4 it is intuitive to explore the combination of SSRIs and psychotherapy for treatment of PTSD. However, to our knowledge, the few studies that have examined this question are limited by small sample sizes, and many focus on samples that demonstrate treatment resistance before initiation of both treatment conditions.5

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