Sertraline Treatment of Posttraumatic Stress Disorder: Results of 24 Weeks of Open-Label Continuation Treatment

Background: Posttraumatic stress disorder(PTSD) is typically associated with a high degree of chronicity,comorbidity, and psychosocial disability. The efficacy ofsertraline in the acute treatment of PTSD has been confirmedbased on the results of 2 large, placebo-controlled studies, butalmost no prospective long-term treatment studies have beenreported.

Method: One hundred twenty-eight patientswho completed 12 weeks of double-blind, placebo-controlled,acute-phase treatment for DSM-III-R-defined PTSD with sertralinewere continued into a 24-week open-label continuation phase.Efficacy was evaluated using the endpoint change in the 17-itemClinician Administered PTSD Scale Part 2 (CAPS-2) severity score,the 15-item patient-rated Impact of Event Scale, and the ClinicalGlobal Impressions-Improvement and -Severity of Illness scales asprimary outcome measures. Treatment response was defined as >=30% decrease in the CAPS-2 total severity score (compared withacute-phase baseline score) and a Clinical GlobalImpressions-Improvement score of 1 or 2.

Results: Ninety-two percent of acute-phaseresponders maintained their response during the full 6 months ofcontinuation treatment. In addition, 54% of acute-phasenonresponders converted to responder status during continuationtherapy. Over the 36-week course of acute and continuationtherapy, 20% to 25% of the improvement in the CAPS-2 severityscore occurred during the continuation phase. Sertraline was welltolerated, with 8.6% of patients discontinuing due to adverseevents. A high pretreatment CAPS-2 score (> 75) predicted alonger time to response and a greater likelihood that responseoccurred after 12 weeks of acute treatment.

Conclusion: The acute efficacy of sertraline issustained in the vast majority of patients, and at least half ofnonresponders to acute treatment will eventually respond tocontinued treatment.