COMBINED MIRTAZAPINE AND SSRI TREATMENT OF PTSD: A PLACEBO-CONTROLLED TRIAL.

BACKGROUND: Combined treatment with a selective serotonin reuptake inhibitor (SSRI) plus mirtazapine has shown superior efficacy in some studies of depression, but has not been studied in posttraumatic stress disorder (PTSD). This study aimed to assess acceptability of combined sertraline plus mirtazapine treatment for PTSD and to estimate its effect size relative to sertraline plus placebo. METHODS: Thirty-six adults with PTSD were randomized to 24 weeks of double-blind treatment with sertraline plus mirtazapine or sertraline plus placebo. Outcomes were analyzed with mixed effects models. RESULTS: The combined treatment group showed a significantly greater remission rate (P = .042) and improvement in depressive symptoms (P = .023) than the sertraline plus placebo group. There were no significant group differences in the two primary outcomes of treatment retention and PTSD severity, or in other secondary outcomes (sleep impairment, sexual functioning, quality of life, and physical and mental functioning), but the combined treatment group showed numerical advantages on all of these outcomes, and effect sizes relative to sertraline plus placebo ranged from small to moderate (d = .26-.63). Both treatments were well-tolerated, with significantly increased appetite but not weight gain in the combined treatment group. CONCLUSION: Findings suggest that combined treatment of PTSD with sertraline plus mirtazapine may have clinically meaningful advantages in symptomatic improvement, relative to SSRI treatment alone, and acceptable tolerability. Combined treatment with an SSRI plus mirtazapine in PTSD deserves additional study as initial treatment or as an augmentation strategy for nonresponders to an SSRI.

Trauma-focused psychotherapy after a trial of medication for chronic PTSD: pilot observations.

BACKGROUND: To date, all clinical trials using a single therapeutic modality (psychotherapy or pharmacotherapy) have found that even the best validated treatments for adults with chronic Posttraumatic Stress Disorder (PTSD) leave a substantial proportion of patients with disabling residual symptoms. METHOD: We reviewed the treatment course of three research patients with PTSD who received trauma-focused psychotherapy after experiencing a partial response to medication. Structured diagnostic interviews, validated symptom measures, and standardized treatment approaches were used to assess treatment response. RESULTS: All patients partially benefited from medication treatment, and the degree of benefit varied substantially. Also, all patients experienced an additional reduction in PTSD symptoms after a time-limited course of prolonged exposure therapy (PE). This finding differs from anecdotal observations among U.S. War veterans and has never been documented systematically among civilian adults with chronic PTSD. CONCLUSION: Maximizing treatment outcome in adults with chronic PTSD may require additional psychotherapy after a partial medication response, and further study is warranted.

El impacto psicológico de los ataques terroristas del 11 de septiembre de 2001 en la ciudad de Nueva York: el trastorno por estrés postraumático y la recuperación de una ciudad traumatizada / Psychological impact of terrorist attacks on september 11, 2001 in New York City: posttraumatic stress disorder and the recuperation of a traumatized city

The terrorist attacks on the World Trade Center (WTC) on September 11, 2001 strained the emotional resources of many New York City residents. The expectation of another terrorist attack, including the fear of bio-terrorism, complicates the recovery process of individuals who were directly affected by the disaster. These individuals are experiencing an amalgan of psychological problems, including Posttraumatic Stress Disorder (PTSD), depression, anxiety, traumatic grief, and self-destructive behaviors. In addition, for some victims, the collapse of the WTC was experienced within a religious context of an apocalyptic nature (e.g., "doomsday" or "the end of the world"). To date, this has been the deadliest act of terrorism in the United States. In this paper we discuss the following: (1) the immediate mental health effects of the terrorist attacks, (2) the prevalence of PTSD before and after September 11, 2001, (3) vulnerability factors implicated in the development of PTSD, (4) the immediate responses to the disaster by government, private, and academic institutions, and (5) a brief description of evidence-based treatments for PTSD. The paper concludes with an account of the horrific and terrifying experience of a WTC survivor.

Los ataques terroristas a las Torres Gemelas el 11 de septiembre de 2001 abrumaron los mecanismos psicológicos que utilizan diariamente los neoyorquinos para enfrentar el estrés. La expectativa de otro ataque terrorista, incluyendo el temor al bioterrorismo, complica el proceso de recuperación de muchos individuos afectados directamente por el desastre. Estas personas experimentan una combinación de problemas psicológicos, incluyendo el Trastorno por Estrés Postraumático (TEPT), la depresión, la ansiedad, el duelo traumático, y las conductas auto-destructivas. Además, algunas víctimas vivieron el desplome de las Torres Gemelas dentro de un marco religioso de naturaleza apocalíptica (por ejemplo, "el dia del juicio final" o "el fin del mundo"). Hasta la fecha, éste ha sido el acto terrorista más mortífero en la historia de Estados Unidos. En este artículo discutimos los siguientes temas: (1) el efecto psicólogico inmediato de los ataques terroristas, (2) la prevalencia del TEPT antes de y después del 11 de septiembre de 2001, (3) los factores que aumentan la vulnerabilidad para presentar el TEPT, (4) las respuestas inmediatas al desastre de parte de las instituciones gubernamentales, privadas y académicas, y (5) una descripción breve de los tratamientos para el TEPT avalados por la evidencia científica. El artículo concluye con un relato de la horrible y aterradora experiencia de un sobreviviente de los ataques.