title: Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial.
abstract: OBJECTIVE
  Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD.
  
  
  METHODS
  Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment.
  
  
  RESULTS
  Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences.
  
  
  CONCLUSIONS
  Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods.
authors: Trauma and Post Traumatic Stress Disorder Program, Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, USA. frs1@columbia.edu
authors: Franklin R
authors: FR
authors: Schneier
authors: Yuval
authors: Y
authors: Neria
authors: Martina
authors: M
authors: Pavlicova
authors: Elizabeth
authors: E
authors: Hembree
authors: Eun Jung
authors: EJ
authors: Suh
authors: Lawrence
authors: L
authors: Amsel
authors: Randall D
authors: RD
authors: Marshall
mesh_terms: D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009519:New York City; D017374:Paroxetine / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors