More Evidence Needed on Post-Traumatic Stress Disorder, Report Finds

There is not enough scientific evidence to determine which treatments for post-traumatic stress disorder are most effective, according to a Institute of Medicine report released Thursday, the AP/Long Island Newsday reports.

However, despite the lack of evidence, patients undergoing treatment should continue to receive the care deemed most appropriate by their physicians, the report emphasized.

The Department of Veterans Affairs, which is seeking advice before updating its treatment guidelines, requested that IOM conduct the analysis (AP/Long Island Newsday , 10/18).

PTSD is the most commonly diagnosed mental disorder among returning soldiers, affecting 12.6% of Iraq War veterans and 6.2% of veterans who served in Afghanistan, according to the report. The report was based on 53 drug studies and 37 studies on psychological treatments for PTSD (Reuters/New York Times, 10/19).

According to the report, the only proven treatment for PTSD is exposure therapy, during which patients are exposed to sights and sounds that simulate their traumatic experiences to help them learn to cope (AP/Long Island Newsday, 10/18). Other psychological treatments for PTSD are not supported by scientific evidence. Those include cognitive restructuring, coping skills training, eye-movement desensitization and reprocessing therapy, and group therapy, the Washington Post reports. The report also did not find evidence to show that medications were effective in treating PTSD.

According to the report, most of the research on drug treatments for PTSD has been collected by pharmaceutical companies or by researchers with conflicts of interest, leading to a lack of unbiased, rigorous proof (Vedantam, Washington Post, 10/19).

Conducting research involving patients with PTSD can be challenging, according to AP/Newsday (AP/Long Island Newsday, 10/18). Alfred Berg, the panel's chair and a professor of family medicine at the University of Washington, said, "We found much of the research on PTSD to have major limitations when judged against contemporary standards for conducting trials" (Washington Post, 10/19).

Antonette Zeiss, a clinical psychologist and deputy chief of the VA's mental health services, said department officials "will redouble our efforts to ensure our mental health staff are trained to provide these effective [exposure] psychotherapies." She noted, "The other treatments have not definitely been shown to be effective. That's different from being shown to be ineffective," adding, "They are some of the best clinical tools we have. But we should continue to try to understand them better, understand for whom they work."

David Matchar, a professor of medicine at Duke University and co-author of the report, said, "The take-home message for patients should be that they seek care," adding, "That is the way medicine is practiced -- we do the best we can with what we've got." He also noted that "we need better" (AP/Long Island Newsday, 10/18).

An abstract of the study is available online.

The number of veterans seeking PTSD treatment from the VA has increased almost 70% from June 30, 2006, to June 30, 2007, according to department records, USA Today reports.

According to the VA, mental health is the second-largest area of illnesses for which Iraq and Afghanistan veterans seek treatment, behind orthopedic problems, although the rate of veterans seeking treatment for mental illnesses is increasing at a more rapid rate (Zoroya, USA Today, 10/19).