Psychological Interventions for Adult Post-Traumatic Stress Disorder Are Effective Irrespective of Concurrent Psychotropic Medication Intake: A Meta-Analysis of Randomized Controlled Trials

Abstract

<b><i>Background:</i></b> Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD). <b><i>Objectives:</i></b> We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy. <b><i>Method:</i></b> To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) <i>N</i> ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported. <b><i>Results:</i></b> Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (<i>N</i> = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (<i>g</i> = 0.87, 95% CI 0.53–1.22) rather than unmedicated (<i>g</i> = 0.27; 95% CI 0.01–0.54, <i>p</i> = 0.017), with younger age (<i>b</i>₁ = −0.04, <i>p</i> = 0.008) and higher proportion of females (<i>b</i>₁ = 0.01, <i>p</i> = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up. <b><i>Conclusions:</i></b> Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.