Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review

Objective: To review the literature from the last twenty years on pharmacological treatments for post-traumatic stress disorder to clarify questions about the efficacy and tolerability of pharmacotherapy and the superiority of one specific agent over another for creating a treatment guideline based on levels of evidence. Methods: Randomized clinical trials and systematic reviews were searched in Medline-PubMed, PsycINFO, Web of Science, Scielo, and Lilacs. The screening of the criteria established by the Transparent Reporting of Systematic Reviews and Meta-Analyses was used, followed by the analysis of risk of bias of the Critical Appraisal Skills Programme. Lastly, the level of evidence and grade of recommendation was acquired, following the Oxford Center for Evidence-based Medicine 2009 Levels of Evidence. Results: The search retrieved double-blind, randomized and placebo-controlled clinical trials. Comparative clinical trials between different drugs were also evaluated and systematic reviews on drug efficacy and meta-analyses. A total of 1.458 studies were found; 58 of these studies were pre-selected and the final sample was composed of 20 studies. Conclusions: Of the 17 drugs included, the following is the order of recommendation based on the levels of evidence established in this study - 1st sertraline; 2nd venlafaxine and paroxetine; 3rd atypical antipsychotics.