Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis

Jia, Y., Ye, Z., et al. (2025).

Therapeutic advances in psychopharmacology,

15, 20451253251342628.

https://doi.org/10.1177/20451253251342628

Abstract

Background: Post-traumatic stress disorder (PTSD) is a prevalent mental illness with a high disability rate. The neurobiological abnormalities in PTSD suggest that drug therapy may have certain therapeutic effects. According to the recommendations of clinical guidelines for PTSD, the current clinical preference is for selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Nevertheless, the efficacy of other types of drugs remains uncertain, which impacts the selection of personalized treatment for patients.

Objectives: The aim of this meta-analysis was to assess the efficacy and acceptability of drugs with different pharmacological mechanisms in alleviating PTSD symptoms by comparing the response rates and dropout rates of different drug treatment groups in randomized clinical trials.

Design: Systematic review and meta-analysis.

Methods: We searched and analyzed 52 reports that described the efficacy and acceptability of medication for PTSD. Among these, 49 trials used the dropout rate as an acceptability indicator, and 52 trials used the response rate as an efficacy indicator.

Results: In the 49 trials with the dropout rate as the indicator, the dropout rate was 29% (95% confidence interval, 0.26-0.33; n = 3870). In the 52 trials with the response rate as the indicator, the response rate was 39% (95% confidence interval, 0.33-0.45; n = 3808). After drug treatment, the core symptoms of PTSD were significantly improved. This meta-analysis indicated that there was no significant difference between antidepressants and antipsychotics in improving clinical symptoms and acceptability. However, antidepressants may have a slight advantage in efficacy, although with a higher dropout rate.

Conclusion: Drug treatment is an effective rehabilitation method for PTSD patients, and individualized drug management should be considered.

Plain language summary

The purpose of this study was to assess the acceptability and efficacy of all types of pharmacotherapeutic agents in reducing the symptoms of PTSD. In this systematic meta-analysis, the dropout and response rates of various pharmacotherapy groups reported by randomized clinical trials were compared. A total of 52 reports that described the acceptability and efficacy of PTSD pharmacotherapies were retrieved and analyzed. This meta-analysis supports antidepressants and antipsychotics have no significant difference

in improving clinical symptoms and acceptabity, however, AAs may has a slight advantage tendency in efficacy, albeit with a higher dropout rate, so individualized drug management should be considered.

Education is Effective in Improving Students’ Ethical and Moral Outcomes: A Systematic Review and Meta-Analysis

Basarkod, G., Cahill, L., et al. (2024, November 20).

https://doi.org/10.31234/osf.io/xv536

Abstract

Addressing society's greatest challenges, such as climate change, requires us to act as moral agents. If effective, interventions within schools and universities could cultivate ethical and moral attributes in millions of people. In this pre-registered systematic review and meta-analysis, we synthesized evidence from 66 randomized controlled trials of interventions at primary, secondary, and tertiary education levels (k=246; 9,978 students). Educational interventions effectively improved students’ moral outcomes of sensitivity, judgment, motivation, and character compared to control groups (g = 0.54; n = 45; k = 133). Interventions involving student discussions were more effective than those relying solely on unidirectional or passive transfer of information. This finding was confirmed through studies comparing two alternate ethics interventions (n = 38; k = 113). Overall, our review shows that educational interventions can improve students’ ethical and moral attributes and provides insights for prioritizing and planning future interventions to increase these attributes at scale.

Here are some thoughts:

This pre-print manuscript details a meta-analysis of 66 randomized controlled trials investigating the effectiveness of ethics interventions in educational settings. The study, conducted across various educational levels and disciplines, found that interventions incorporating student discussions significantly improved students' moral outcomes compared to control groups or interventions solely using didactic methods. The analysis also explored moderators such as education level, intervention style, and risk of bias, revealing nuanced insights into the effectiveness of different approaches to ethics education. Importantly, the researchers emphasized the need for further research to improve study design and broaden geographical representation.

Remotely administered non-deceptive placebos reduce COVID-related stress, anxiety, and depression

Guevarra, D. A., Webster, C. T, et al. (2024).

Applied Psychology Health and Well-Being.

https://doi.org/10.1111/aphw.12583

Abstract

Research suggests that placebos administered without deception (i.e. non-deceptive placebos) may provide an effective and low-effort intervention to manage stress and improve mental health. However, whether non-deceptive placebos administered remotely online can manage distress for people at risk for developing high levels of affective symptoms remains unclear. Volunteers experiencing prolonged stress from the COVID-19 pandemic were recruited into a randomized controlled trial to examine the efficacy of a non-deceptive placebo intervention administered remotely online on affective outcomes. COVID-related stress, overall stress, anxiety, and depression were assessed at baseline, midpoint, and endpoint. Compared with the control group, participants in the non-deceptive placebo group reported significant reductions from baseline in all primary affective outcomes after 2 weeks. Additionally, participants in the non-deceptive placebo group found the intervention feasible, acceptable, and appropriate for the context. Non-deceptive placebos, even when administered remotely online, offer an alternative and effective way to help people manage prolonged stress. Future large-scale studies are needed to determine if non-deceptive placebos can be effective across different prolonged stress situations and for clinical populations.

The article is linked above.

Here are some thoughts:

Non-deceptive placebos (NDPs) have shown promise as an effective and low-effort intervention for managing stress and improving mental health, even when administered remotely online. A randomized controlled trial examined the efficacy of NDPs on volunteers experiencing prolonged stress from the COVID-19 pandemic. The study found that participants in the NDP group reported significant reductions in COVID-related stress, overall stress, anxiety, and depression compared to the control group after just two weeks. The effect sizes were comparable to those seen in self-guided online cognitive behavioral therapy programs. Participants in the NDP group also reported high expectations of benefits and found the intervention feasible, acceptable, and appropriate for the context. These findings suggest that NDPs, even when administered remotely, can help moderately at-risk individuals manage their psychological health during prolonged stressful situations. The study's results are consistent with previous research showing positive effects of NDPs on affect-related outcomes. However, the researchers noted some limitations, including a small and demographically limited sample size, potential response bias, and the need for more diverse and larger-scale studies. Despite these limitations, the study highlights the potential of NDPs as a scalable, easily implementable secondary intervention to help prevent medium-risk populations from progressing to clinical levels of affective symptoms. Future research should focus on examining the efficacy of NDPs across different stress situations and for clinical populations, as well as investigating the mechanisms through which NDPs exert their effects.

I often think about psychotherapy's potential placebo effects (and how to possibly incorporate this into my informed consent to treatment). Psychotherapy's relationship to placebo effects is a complex and debated topic in the field of mental health. While psychotherapy shares some key mechanisms with placebos, such as the importance of patient expectations, the therapeutic alliance, and nonspecific factors like empathy and attention, it would be overly reductive to label psychotherapy as merely a placebo. Psychotherapy has specific, theorized mechanisms of action and has been shown in well-designed studies to outperform placebo controls, albeit sometimes by small margins. However, the similarities between psychotherapy and placebo effects highlight the importance of these "common factors" in treatment outcomes.  Mental health professionals need to consider the potential placebo effects in psychotherapy.