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Combining Prolonged Exposure Treatment with Sertraline Enhances Therapy of Post-Traumatic Stress Disorder: Presented at ADAA

By Alison Palkhivala

TORONTO, ON -- April 1, 2003 -- In patients with post-traumatic stress disorder (PTSD), combining prolonged exposure treatment, a form of cognitive-behavioral therapy in which patients repeatedly confront and vividly relive memories of trauma, with a short course of sertaline can help prolong and enhance the benefits obtained with sertraline alone.

Shawn P. Cahill, PhD, from the University of Pennsylvania, Philadelphia, United States, presented the findings here in a poster on March 29^th at the 23^rd Annual Conference of the Anxiety Disorders Association of America.

His team of researchers enrolled 63 patients with PTSD who had previously responded to a 10-week course of sertraline. Patients were randomized to treatment with sertraline only or sertraline plus 10 sessions of prolonged exposure for an additional 5 weeks.

Response to therapy was measured using the structured interview for PTSD (SIP), Beck Depression Inventory (BDI) and the State-Anxiety portion of the State-Trait Anxiety Inventory (STAI-S).

Patients in both groups improved significantly with respect to measurements on all 3 scales by the end of the 15-week trial, with some additional benefit seen among those who underwent prolonged exposure. At the 6-month follow-up, patients who received prolonged exposure in addition to sertraline therapy tended to maintain their gains better than those who took sertraline alone.

By week 15, 59.1% of those who took sertraline along with prolonged exposure and 56.5% of patients who took sertraline alone achieved good end state functioning. This was defined as at least a 50% reduction in SIP score, a BDI score of 10 or less and a STAI-S score of 40 or less.

At week 40, however, 71.4% of those who took sertraline along with prolonged exposure compared to 43.5% of patients who took sertraline alone had good end state functioning. This difference approached but did not quite reach statistical significance (P=0.062).

"With 10 weeks of medication, people are getting better on all 3 measures," said Dr. Cahill. "[But] even though we're getting toward the lower end of the scale, there is an augmentation effect [for prolonged exposure]. Adding therapy is improving outcome, to some extent. … We're [also] getting a pretty good relapse prevention effect, if people achieve good end state functioning."

This study was sponsored by an educational grant from Pfizer, Inc., manufacturer of sertraline.


[Study title: Augmentation of Sertraline with Prolonged Exposure (PE) in the Treatment of PTSD: Does PE Protect against Relapse when Medication is Discontinued? Abstract p92.]

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