Heike Gerger, PhD: Further Studies of PTSD Treatment Needed

Heike Gerger, PhD

A new meta-analysis comparing psychotherapeutic and pharmacological treatments for posttraumatic stress disorder (PTSD) exposed the profound lack of studies from which to draw data.

Despite the prevalence, high risk of chronicity, comorbidity, and functional impairment associated with PTSD, research on which form of treatment ought to be preferred is stretched tenuously thin. Patients are more frequently directed to psychotherapeutic avenues of treatment, but the amount of data to support that decision, beyond clinicians’ anecdotal preferences, is minimal.

The meta-analysis, “Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder: A Meta-analysis,” was published by JAMA Psychiatry and previously covered by MD Magazine®. Heike Gerger, PhD, of the University of Basel (UNIBAS), led the team of investigators.

Gerger spoke to MD Mag about the meta-analysis’ significance, the dearth of available studies, and how research regarding the most effective treatments for PTSD ought to progress in the future.

MD Mag: What was the most important finding in this study?

Gerger: The ridiculously small number of available studies.

Where should future studies of how to best treat PTSD concentrate their efforts?

Large-scaled comparative trials preferably including all three approaches (i.e., psychotherapeutic and pharmacological treatments and the combination of the 2) reporting long-term outcomes are urgently needed.

Given that many patients ask for medication, and in the face of the increasing amount of research demonstrating considerable benefits of placebo pills, for future research it would also be interesting to compare the effects of combining psychotherapeutic treatments and placebo pills with the effects seen in either psychotherapeutic or pharmacological or combined treatments.

Why is there such a lack of research regarding treatment despite the estimated 8% of people who have PTSD?

There is not a lack of research on PTSD treatment in general. Meta-analyses on psychotherapeutic treatments identified many RCTs (e.g. Gerger et al., Psychological Medicine, 2014 included 66 RCTs), just as did meta-analyses on pharmacological treatments (e.g. Cipriani et al., Psychological Medicine, 2017 included 51 RCTs). Just, RCTs comparing different kinds of treatment—i.e. psychotherapeutic and pharmacological treatments or their combination—are scarce.

One reason for this observation may be that researchers (and clinicians) tend to have a rather strong preference for one or the other kind of treatment. In their studies they then use the treatment they expect to be most efficacious in order to prove its efficacy.

Therefore, in many cases, only one kind of treatment is compared with control treatments. This is particularly problematic if we want to determine which treatment is best suited for which patients.

What was the most surprising finding in this study?

Gerger: Researchers conducting meta-analyses have read the included studies several times before conducting the final analyses. Therefore, especially when the number of studies is as small as in this meta-analysis, the results are not very surprising in the end.