In a new study, researchers comparing three treatments for Veterans with PTSD found that the longer the time period between trauma and treatment, the greater the decline in symptoms.
The results appeared in the Journal of Clinical Psychiatry in June 2021.
Dr. Sheila Rauch, director of mental health research and program evaluation at the Atlanta VA Health Care System, led the study. Despite the surprising finding, she says Veterans with PTSD should not delay treatment thinking that their symptoms will improve over time.
“Their symptoms are unlikely to subside without treatment,” she says. “All of the Veterans in the study showed reductions and benefit. It means that they do not have to worry if they have been suffering a long time with PTSD because treatments do work regardless of how long it has been.”
The three treatments in the study are as follows:
- A placebo drug plus prolonged exposure, one of the premier trauma-focused psychotherapies in VA for patients with PTSD;
- Prolonged exposure plus the medication sertraline (trade name Zoloft), one of two drugs the U.S. Food and Drug Administration (FDA) has approved for treating PTSD;
- Sertraline plus enhanced medication management, a way of optimizing treatment that goes beyond standard care with a more comprehensive patient follow-up and review of his or her condition and symptoms.
Treatments show large reductions in PTSD symptoms
Among the nearly 200 patients in the study, time since trauma (TST) ranged from half a year to 15 years. “The finding that longer TST shows larger symptom reductions is promising for PTSD patients who might not seek help for years following trauma,” the researchers write.
Rauch and her colleagues concluded through interviews and Veteran self-reporting that a longer time period between trauma and treatment predicted greater PTSD symptom reduction after six months of treatment. Notably, all three treatments produced large declines in PTSD symptoms, with no major differences in reduced symptoms. But Rauch stresses that these are aggregate findings, and that individual patients may do better with certain treatments.
“We expected all of these treatments to reduce PTSD over six months,” she says, “though we did expect the treatment with medication and enhanced medication management to have a smaller effect. We were pleasantly surprised that all of the treatments showed large reductions. This means that Veterans with PTSD have good medication and therapy options.”
‘The rationale for why we did the study’
The researchers also found that higher baseline physical pain severity strongly predicted a lesser and slower response to all three treatments, suggesting a common pattern in the nervous system among those patients. Plus, alcohol use did not impede the effectiveness of medication for PTSD, although many clinicians worry about how alcohol interacts with drugs intended to treat PTSD, Rauch says.
“Despite overall equivalence in outcomes, variability in response is apparent and examination of whether certain baseline variables may predict greater response overall or greater response within a treatment condition is still warranted,” the researchers write.
Researcher a VA leader in PTSD treatment
Rauch led a 2018 study that examined the same three treatments. That study also showed no group level difference in PTSD symptoms or symptom severity at 24 weeks. However, there was individual variability in how much PTSD symptoms changed. “That is the rationale for why we did the  study,” Rauch says. “We wanted to see if there were baseline factors that predicted who may do better in what treatment. If there are, then we can use that information to start people in the treatment that is most likely to be effective.”
Rauch is a VA leader in PTSD treatment. Her research aims to expand access to effective PTSD treatments and to figure out how to make those treatments work faster and more efficiently for people.
“My collaborators and I want to get what works out to people who are suffering from PTSD and other issues after trauma and need help,” she says.
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