CRITICAL APPRAISAL

Authors

: Mathew Hoskins, Jennifer Pearce, Andrew Bethell, Liliya Dankova,

Corrado Barbui, Wietse A. Tol, Mark van Ommeren, Joop de Jong, Soraya
Seedat, Hanhui Chen and Jonathan I. Bisson

Title

: Pharmacotherapy for post-traumatic stress disorder: systematic review and

meta-analysis
The British Journal of Psychiatry/ Published online February 2, 2015

A. ARE THE STUDY RESULTS VALID?

1. Was the assignment of patients to treatment groups truly Yes
randomized?
Can be seen in the method :
A systematic review and

meta-analysis of

randomized

controlled trials was undertaken; 51 studies were included.

2. Were all patients who entered the study accounted for No
appropriately at the end?
No, All patients that screened at the start were not appropriately
accounted at the end.
i) Is the number of blind test the same as in results?
The number of blind test is not same as in results.
ii) Were patients analysed in the groups they were allocated to
at the start of the study?
No, They were not allocated to at the start of the study

3. Were patients, physicians, and those doing the assessments Yes

blind test to treatment?
In this study, there is not only double-blind for the evaluator.
Can be seen in the method :
All double-blind, randomized, placebo-controlled and
comparative trials of the pharmacological treatment of PTSD
completed from October 2005 (to ensure all eligible trials not

published at the time of the NICE, Cochrane and ACPMH

searches would be included) were considered in our primary
and additional searches, covering13 separate databases.
4. Was similarity between groups documented?
Yes
i) Is there a table of baseline characteristics?
Yes, there are two tables of baseline characteristics.
ii) Were differences controlled for in the analysis?
Yes, there were criteria that controlled the differences
from the analysis. Pharmacological treatments for adults
with PTSD, in which the comparator was a placebo or
other

medication,

were

eligible

for

inclusion.

Pharmacotherapy trials in which there was ongoing or

newly initiated trauma-focused psychotherapy or where
the experimental medication served as an augmentation
agent to ongoing pharmacotherapy were excluded. Studies
that were clearly irrelevant were excluded. Allowed
concomitant psychotropic medications was
excluded
5. Were the groups treated in the same way?
No
No, The groups treated in different way, such as double-blind,
randomized, placebo-controlled and comparative trials of the
pharmacological treatment of PTSD

B. WHAT WERE THE RESULTS?

1. How large was the treatment effect?
The effect sizes for pharmacological treatments for PTSD compared with placebo
are low and inferior to those reported for psychological treatments with a trauma
focus over waiting-list or treatment as usual controls
2. How precise was the estimate of the treatment effect?
Selective serotonin reuptake inhibitors were found to be statistically superior to
placebo in reduction

of

PTSD symptoms but the

effect size

was

small

(standardised mean difference -0.23, 95% CI -0.33 to -0.12).

C. CAN THE RESULTS BE APPLIED TO YOUR PATIENTS?
1. Can the results be applied to my patient (care)?
Yes
Some drugs have a small positive impact on PTSD
symptoms and are acceptable. Fluoxetine, paroxetine and

venlafaxine may be considered as potential treatments for

the disorder.
2. Were all clinically

important

outcomes

reported? Not yet

Pharmacological interventions for PTSD can be effective but

the magnitude of effect unfortunately is small, and the clinical
relevance of this small effect is unclear. This review supports
the use of

paroxetine, venlafaxine and fluoxetine

as

pharmacological interventions for PTSD. For most drugs, there

remains inadequate evidence regarding efficacy for PTSD,
pointing

to

the

need for more research in this area to

confirm the utility of pharmacological treatments for this

disorder
i)
Were the most important outcomes used? The drug achieve
the targets medication adherence, mood regulation, sleep,
ii)

social functioning, and coping with symptoms.

Were quality of life outcomes used? Assessment of adverse

effects? There is no outcomes reported yet.

3. Are the likely treatment benefits greater than the potential Unknown
harms and costs?
There is no data available.
CONCLUSIONS
The results or recommendations are valid (from A).
The results are clinically important (from B).
The results are relevant to my practice (from C).

Yes
Yes
Yes