Use of pharmacological treatment for posttraumatic stress disorder: Analysis of a psychiatric population in Switzerland and comparison with international guidelines

Several international guidelines for the pharmacological treatment of posttraumatic stress disorder (PTSD) have been published. However, it is unclear whether clinicians use these procedures in their daily practice. We compared the psychopharmacological prescription patterns in a Swiss adult psychiatric center with international clinical guidelines at admission and discharge. Retrospective chart review study between 2005 and 2015 of adult patients with PTSD and no other documented psychiatric comorbidity. Fifty-two outpatients and 21 inpatients were included; 47% had at least one psychopharmacological treatment at admission. Among them, 47% had one or several antidepressants, mainly escitalopram (31%, n=5) or citalopram. At discharge, 68% had at least one psychopharmacological treatment. Among them, 76% had at least one antidepressant, mainly escitalopram (34%, n=13) or mirtazapine (21%, n=8). They were compared to the guidelines of the Department of Veterans Affairs and Department of Defense (VA/DoD), showing 19% of the patients treated with antidepressants at admission were in agreement with the guidelines (sertraline, fluoxetine, paroxetine, venlafaxine), and 26% at discharge. In addition, we found prescriptions of benzodiazepines (62% at admission and 50% at discharge), antipsychotics (12% and 22%), Z-drugs (zolpidem, zopiclone: 15 and 40%) and a few pregabalin prescriptions (n=4). Clinicians in this study frequently prescribed antidepressants to treat PTSD, as recommended. However, most of the antidepressants used were not recommended in the VA/DoD guidelines. Benzodiazepines and Z-drugs remained widely used, although they are not recommended. Il existe plusieurs recommandations internationales concernant le traitement de l’état de stress post-traumatique (ESPT). Cependant, leur utilisation dans la pratique clinique reste rarement évaluée. Nous avons comparé les prescriptions pharmacologiques effectuées dans un centre public suisse avec les recommandations internationales. Étude rétrospective sur dossier des prescriptions pharmacologiques effectuées entre 2005 et 2015 chez des patients adultes avec un état de stress post-traumatique sans autre comorbidité. Les traitements présents à l’entrée et à la sortie d’unités ambulatoires et hospitalières ont été pris en compte. Nous avons analysé différentes classes de traitements, dont les antidépresseurs, les antipsychotiques, les stabilisateurs d’humeur (antiépileptiques), les benzodiazépines et leurs analog