Report: PTSD Treatments Need More Study

There is not enough evidence to tell if most treatments for post-traumatic stress disorder work, says a scientific review that highlights the urgency of finding answers as thousands of suffering veterans return from Iraq.

The one proven treatment: So-called exposure therapies, where PTSD patients are gradually exposed to sights and sounds that essentially simulate their trauma, to help them learn to cope, advisers to the government reported Thursday.

The lack of evidence for other therapies does not mean patients should give them up - they still should get whatever care their personal doctors deem most promising, stressed Thursday's report from the Institute of Medicine.

"The take-home message for patients should be that they seek care," said Dr. David Matchar of Duke University, who co-authored the report.

"That is the way medicine is practiced - we do the best we can with what we've got," he added. But, "we need better."

While PTSD was first recognized in Vietnam veterans, war is far from its only trigger. Crime, accidents and other trauma can cause it in civilians, too. Sufferers experience flashbacks and physical symptoms that make them feel as if they are reliving the trauma, even many years later.

Today, PTSD is the most commonly diagnosed mental disorder among veterans returning from Iraq and Afghanistan, affecting an estimated 13 percent and 6 percent of them, respectively, says the new report - which concluded it is not even clear if veterans and civilians will need different types of therapy for PTSD.

Delays in getting care for both mental and physical health problems plague many injured veterans, as the Pentagon and Department of Veterans Affairs struggle with backlogs in processing disability benefits and in coordinating services. Ensuring prompt PTSD care was a key recommendation of a presidential panel appointed last summer to investigate those problems.

Thursday's report addresses a somewhat different issue: Once a patient arrives for treatment, what to offer? The VA asked the prestigious Institute of Medicine to review the scientific evidence for a variety of medications and psychological treatments - before the department updates its own treatment guidelines.

Exposure therapies already are offered in the VA system, and "we will redouble our efforts to ensure our mental health staff are trained to provide these effective psychotherapies," said Antonette Zeiss, a clinical psychologist who is deputy chief of VA's mental health services.

Other existing treatments will remain, too, she said, but VA officials planned to meet Thursday to begin planning new research to better prove their value.

"The other treatments have not definitely been shown to be effective. That's different from being shown to be ineffective," Zeiss cautioned. "They are some of the best clinical tools we have. But we should continue to try to understand them better, understand for whom they work."

The report's authors noted that the majority of drug studies and many of the psychotherapy studies were conducted by individuals or companies responsible for their development. They recommended that PTSD treatment research be broadened to ensure findings are not compromised by conflicts of interest.

Other recommendations to the V.A. include: Improve the internal validity of research, particularly in standardization of treatment and outcome measures; Work with clinicians to help identify the most important subpopulations of veterans with PTSD and design studies of interventions tailored to those subpopulations; and promote and support research on early intervention in PTSD.

AP Medical Writer Lauran Neergard contributed to this report.


PTSD Treatment Facts

PTSD:

First recognized in Vietnam war veterans

Most commonly diagnosed mental disorder among veterans returning from Iraq and Afghanistan, affecting 13 percent of Iraq vets and 6 percent of Afghan vets

Backlog of vets seeking treatment

Unclear if veterans and civilians need different types of therapy

Triggers:

War

Crime

Accidents

Other trauma

Symptoms:

Flashbacks

Patients feel as if they are reliving the trauma, even years later

One proven treatment: so-called "exposure therapies"

Patients gradually exposed to sights, sounds that simulate their trauma

Helps them learn to cope

Now offered in the VA system

The report from the Institute of Medicine, "Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence," says there is insufficient information on whether other treatments working, but also that patients should still should get whatever care their doctors deem most
promising. Among the treatments the report recommends seeking additional evidence:

Pharmacotherapies:

Alpha-adrenergic blocker prazosin;

Anticonvulsants;

Novel antipsychotics olanzapine and risperidone;

Benzodiazepines;

MAOIs phenelzine and brpfaromine;

SSRIs;

Other antidepressants;

Other drugs (naltrexone, cycloserine, or inositol)

Psychotherapies:

EMDR;

Cognitive restructuring;

Coping skills training;

Group format psychotherapy