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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3060 — Pharmacoepidemiology of PTSD Treatment

Author List:
Sernyak MJ (VISN 1 MIRECC)
Rosenheck R (NEPEC)

Objectives:
The treatment of PTSD is an area of special emphasis for the VA. The only FDA-approved medications, sertraline and paroxetine, have demonstrated limited effectiveness in trials involving VA patients. This study was designed to investigate the current psychotropic prescribing practices throughout the VA for patients diagnosed with PTSD.

Methods:
For FY2004, the medication records of all patients with a recorded diagnosis of PTSD were examined. Information about the type of medications prescribed and the number and duration of prescriptions were obtained from PBM files. Additional information about the site of treatment (mental health clinic versus non) and patient clinical and demographic characteristics were also collected.

Results:
In FY2004 222,612 patients diagnosed with PTSD filled a prescription for a psychotropic medication. Within the group of patients receiving any psychotropic medication, 88.6% received an antidepressant; 60.7%, an anxiolytic or sedative/hypnotic; and 33.6%, an antipsychotic. Comparing patients treated in mental health clinics (92.7%) and those treated exclusively in non-mental health clinics (7.3%), prescription rates were similar for antidepressants (89.4% v 77.2%) and anxiolytic/sedative/hypnotics (61.3% v 52.6%) but higher for antipsychotics (35.2% v 13.8%). The strongest predictor of use of the medications was the presence of comorbid psychiatric disorders—e.g. a diagnosis of depression associated with the use of antidepressants, any psychotic disorder associated with antipsychotics, and other anxiety disorders associated with anxiolytic/sedative/hypnotic prescriptions.

Implications:
Prescription rates for antidepressants and anxiolytic/sedative/hypnotics were similar whether treatment occurred within mental health clinics or in other settings. However, antipsychotic prescription was more common within mental health clinics. In addition, the strongest predictor of prescription of the various classes of medications was co-morbid psychiatric diagnosis.

Impacts:
Although antidepressants are the only FDA-approved pharmacotherapy for PTSD, and are widely employed in the VA, other medications are also commonly prescribed. While it is reassuring that there appears to be a straightforward association between comorbid diagnoses and medication choice within the group of patients receiving pharmacotherapy for PTSD, little is known about the effectiveness of these medications in sub-populations of patients with PTSD. Randomized trials of both initiation and discontinuation of these medications are necessary to determine which combinations are effective and which are unnecessary.


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