Switching to the antidepressant venlafaxine led to greater symptom improvement in patients with posttraumatic stress disorder who did not respond to initial treatment, according to a recent study.
In the randomized clinical trial, both brief trauma-focused psychotherapy and pharmacotherapy produced clinically meaningful improvement among primary care patients with posttraumatic stress disorder (PTSD), though treatment engagement was low across groups. The study, published in JAMA Psychiatry, reported that patients receiving written exposure therapy (WET) had similar reductions in symptom severity as those prescribed selective serotonin reuptake inhibitors (SSRIs). Among nonresponders to SSRIs, switching to the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine was significantly more effective than adding WET.
The Sequenced Treatment Effectiveness for Posttraumatic Stress trial enrolled 700 adults (mean age, 45.1 years; 62.1% men) from 7 federally qualified health centers and 8 Veterans Affairs medical centers between April 2021 and June 2024. Participants met diagnostic criteria for PTSD, with a mean baseline Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) score of 52.8, indicating substantial symptom burden. Patients were randomized to one of three treatment sequences: (1) SSRI followed by WET augmentation, (2) SSRI followed by switch to SNRI, or (3) WET followed by SSRI.
At 4 months, patients in the SSRI group demonstrated a mean 14.0-point reduction in PCL-5 scores, while those in the WET group had a mean 12.1-point reduction. The between-group difference was not statistically significant. Engagement differed notably: 51.8% of SSRI-treated patients adhered to medication, compared with 31.5% of WET participants who completed all 6 sessions. Both treatments yielded large within-group effect sizes, with a Cohen d of 1.0 for SSRIs and 0.8 for WET.
Among 122 of 295 patients (41.4%) who did not respond to SSRIs, switching to venlafaxine resulted in a mean 9.2-point reduction in PCL-5 scores compared with a 2.3-point reduction for WET augmentation . Depression, anxiety, and sleep outcomes also favored the SNRI group.
“Study findings suggest that clinically meaningful improvements in PTSD symptom severity can be achieved in primary care with either SSRIs or WET, thus providing clinicians with evidence to recommend either treatment option to their patients,” noted lead author John C. Fortney, PhD, of the Department of Psychiatry and Behavioral Sciences, Division of Population Health, School of Medicine, University of Washington, Seattle, and colleagues.
Full disclosures can be found in the published study.
Source: JAMA Psychiatry
