Psychological interventions for adult post-traumatic stress disorder are effective irrespective of concurrent psychotropic medication intake: A meta-analysis of randomized controlled trials

Hoppen, T. H.; Morina, N.

Abstract

Background: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult PTSD. Objectives: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy. Method: To this end, we searched Medline, PsycINFO, Web of Science and PTSDpubs from inception to April 21st 2022 for trials meeting the following criteria: 1) randomized controlled trial (RCT), 2) PTSD as primary treatment focus, 3) interview-based PTSD baseline rate ≥ 70%, 4) N ≥ 20, 5) mean age ≥ 18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported. Results: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behaviour therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by intake rates in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53-1.22) rather than unmedicated (g = 0.27; 95% CI 0.01-0.54, p = .017), with younger age (b1 = -0.04, p = .008) and higher proportion of females (b1 = 0.01, p = .014) being associated with higher efficacy only in trials with high medication rates. No differences in efficacy by intake rates were found at follow-up. Conclusions: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.