A multiyear clinical trial comparing medication and mental health in the treatment of post-traumatic stress disorder shows that patients who chose their form of treatment-whether drugs or therapy improved more than those who were simply prescribed one or the other regardless of the patient's preference. The study was published in the  American Journal of Psychiatry.

This is the first large-scale trial of hundreds of PTSD patients, including veterans and survivors of sexual assault, to measure if a patient preference in the course of treatment with the effectiveness of a type of cognitive behavioral therapy and use of selective serotonin reuptake inhibitors, a type of antidepressant often prescribed for PTSD.

The study was conducted at outpatient clinics in Seattle and Cleveland. It found that both a medication-Sertraline, marketed as Zoloft and a specific form a therapy is known as prolonged exposure were effective in reducing PTSD symptoms during treatment, with improvements maintained at least two years later.

PTSD Diagnosis

But patients who received their choice between the two possible treatments showed a greater reduction in symptoms, were more apt to stick to their treatment program and even lost their PTSD diagnosis over time.

In any form of healthcare, when receiving a recommendation from a provider, patients may not be given a choice of approaches to their problems. This research suggests that prolonged exposure and Sertraline are both good, evidence-based options for PTSD treatment-and that providing information to make an informed choice of long-term outcomes.

The study was doubly randomized, meaning that participants were randomly assigned to a group in which they received their preferred treatment, or to a group in which they were randomly assigned to one treatment program or the other.

Psychotherapy

Comparing medication to psychotherapy is rare in a clinical trial because it is time- and labor-intensive, Zoellner explained. In this case, both treatments had positive effects, although therapy demonstrated a slight edge.

When both interventions reduce symptoms, it is often difficult to detect a difference because of patients. "Prolonged exposure psychotherapy for PTSD is as good as Sertraline, if not better, for the treatment of PTSD.

When treatment preference is taken into account, results are more dramatic. Of those who wanted and received therapy, 74% had lost their PTSD diagnosis two years later; of those who preferred therapy but received medication instead, only 37% were PTSD-free after two years.

Not all survivors of sexual assault have PTSD or depression, Zoellner pointed out, but those who do not know that short-term therapy or medication can yield significant long-term benefits. Sexual assault often has a long-term impact on the trauma survivor, but for many, it needs to be in the form of chronic psychiatric problems.

Survivors should know good, short options exist and need not suffer in silence. Many people need to be in the form of chronic psychiatric problems Survivors should know good, shorts options exist and need not suffer in silence. 

Chronic PTSD

They showed that we had got two effective, very different interventions for chronic PTSD and associated difficulties. Given this, and the fact that getting to treatment you prefer confers to significant benefit, we are now able to move towards better-personalized treatment for those suffering after trauma.