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Helps 3 in 5 people even without psychotherapy

The antidepressant drug sertraline can provide relief from the disabling emotions that follow a traumatic experience, a study shows.

The study was instrumental in gaining Food and Drug Administration approval for sertraline to treat post-traumatic stress disorder (PTSD), says Dr. Jonathan R.T. Davidson, a professor of psychiatry at Duke University Medical Center who directed the trial. Marketed as Zoloft, it is the only drug in its class to have FDA approval for treatment of PTSD.

While post-traumatic stress disorder was first given formal designation in 1980, it was often seen before that in military personnel who experienced the hells of war (“shell shock” was a common term). It can cause severe psychological problems, including flashbacks to the traumatic experience, depression, emotional numbness, alcoholism and panic attacks, increasing the probability of suicide. Its physical symptoms can include stomach trouble, crippling headaches and a feeling of perpetual exhaustion. Those problems can last for up to five years without treatment.

Any act of violence can trigger post-traumatic stress disorder, Davidson says — sexual assault, childhood or domestic abuse, a serious accident. A sudden death in the family can also be responsible.

“The trauma could be recent or could have occurred years ago,” Davidson adds. “Even a trauma experienced when someone was growing up could have an effect in adult life.”

Sertraline, marketed by Pfizer, is a member of the family called selective serotonin uptake inhibitors. They modify the activity of the brain chemical serotonin, whose function often is affected in depression and stress.

The study, funded by Pfizer and reported in issue of Archives of General Psychiatry, used a 12-week course of sertraline in half of a group of 103 men and women diagnosed with post-traumatic stress disorder. The other half got an inactive ingredient, with neither the doctors nor the patients knowing which was which. It is one of the few PTSD studies done under such double-blind, controlled conditions, Davidson says.

Using two standard scales to measure the effectiveness of the treatment, the researchers say that 60 percent of the patients who got sertraline showed marked improvement, compared to 38 percent of those in the placebo group.

Sertraline was used alone in the study to isolate its effect, Davidson says. In clinical practice, he adds, “you probably would give the medication along with behavioral therapy.”

“Most experts would want to start with psychotherapy,” says Rachel Yehuda, professor of psychiatry at the Mount Sinai School of Medicine in New York and a member of the advisory board of the Anxiety Disorders Association of America. “But there is absolutely no reason not to give the medication, especially if the symptoms are severe.”

One problem is that some patients may balk at taking a psychiatric medication, she says. “They feel it is a sign of weakness,” Yehuda says. “But this is a biological disorder, so there is no reason not to take a medication.”

Other drugs are being used to treat post-traumatic stress disorder, she adds. They include fluoxetine (Prozac) and paroxetine (Paxil), which also act on serotonin, and some antidepressants.

What To Do

Relatives and friends of someone who has gone through a traumatic experience should be alert for symptoms that indicate the need for treatment, Davidson says. Heavy drinking, withdrawal from social contacts, always being on edge and hyperarousal – unusual reactions to minor problems – are signs of trouble.