title: Escitalopram in the prevention of posttraumatic stress disorder: a pilot randomized controlled trial.
abstract: BACKGROUND
  A small literature suggests that pharmacotherapy may be useful in the prophylaxis of posttraumatic stress disorder in patients presenting with major trauma. There is relatively little data, however, on the use of selective serotonin reuptake inhibitors (SSRIs) in this context.
  
  
  METHODS
  24 week, double-blind placebo controlled study. 31 participants presenting immediately after trauma, and meeting diagnostic criteria for full or partial acute stress disorder were randomized to treatment with 10-20 mg of escitalopram or placebo daily for 24 weeks. 2 participants were excluded from the analysis due to early drop out, leaving 29 participants (escitalopram = 12, placebo = 17) for inclusion in an intent- to- treat analysis. Participants were followed up until 56 weeks, and assessed with the Clinician Administered PTSD Scale (CAPS). A mixed model repeated measures analysis of variance (RMANOVA) was undertaken to determine the efficacy of the intervention on the CAPS score.
  
  
  RESULTS
  There was a significant reduction in CAPS score over the course of treatment (F(7, 142) = 41. 58, p < 0.001) in both the escitalopram and placebo groups, with a greater reduction in CAPS score in the placebo group F(7, 142) = 2.12, p = 0.045. There were improvements on all secondary measures, including the Clinical Global Impressions scale, and scales assessing depression, anxiety and disability. Only functional disability outcomes (F(7, 141) = 2.13, p = .04), were significantly different between treatment and placebo groups. In the sample as a whole, improvement in scores were maintained at the 52 week follow-up. Side effects were comparable between the groups.
  
  
  CONCLUSIONS
  These data are consistent with other recent work indicating that the SSRIs may not be efficacious in the prevention of PTSD. Nevertheless, the small sample size and baseline differences between groups limit the explanatory power of the study. Although a consideration of the possibility of medication prophylaxis in PTSD remains important, both from conceptual and clinical perspectives, caution is needed with regards to the use of SSRIs until their efficacy can be proven.
  
  
  BACKGROUND
  Clinical Trials NCT00300313.
authors.affiliation: MRC Anxiety Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa. sharain@sun.ac.za.
authors.forename: Sharain
authors.initials: S
authors.lastname: Suliman
authors.affiliation: MRC Anxiety Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa. sseedat@sun.ac.za.
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.affiliation: MRC Anxiety Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa. j.pingo@hotmail.com.
authors.forename: Janine
authors.initials: J
authors.lastname: Pingo
authors.affiliation: MRC Anxiety Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa. tarynsuth@hotmail.com.
authors.forename: Taryn
authors.initials: T
authors.lastname: Sutherland
authors.affiliation: Department of Psychiatry, Tel-Aviv University, Tel-Aviv, Israel. joseph.zohar@sheba.health.gov.il.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
authors.affiliation: MRC Anxiety Disorders Unit and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. dan.stein@uct.ac.za.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000517:prevention & control*; D015283:Citalopram / Q000008:administration & dosage*; D003863:Depression / Q000517:prevention & control*; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors