Predicting and Managing Treatment Non-response in Posttraumatic Stress Disorder

Summary & key facts

This paper looked at studies about people whose posttraumatic stress disorder does not get better with standard care. The authors found that there is no agreed definition of “treatment resistance” and no reliable tests doctors use to tell who will not improve. Some possible warning signs show up again and again in research, and a few second-line treatments look promising for people who do not respond to psychotherapy or antidepressants. But the review says more research is needed before clinicians can dependably predict non-response or safely steer people to these other options.

Key facts:

• The review found there is no clear, agreed way to define when PTSD is “treatment resistant.”
• Doctors do not have well-tested predictors they can use in routine care to tell who will not improve with first-line treatments.
• Researchers identified several possible predictors that appear in multiple studies. These include being male, having little social support, having long-lasting or childhood trauma, having other psychiatric disorders at the same time, having
• First-line care for PTSD usually means trauma-focused psychotherapy and antidepressant medicines. Some people do not get better with these treatments.
• For people who do not respond to first-line care, the treatments that currently look most promising are magnetic brain stimulation and ketamine given as an infusion. These are not risk-free and need careful judgment.
• Psychotherapy that uses the drug MDMA also looks promising based on research studies, but it is not an approved treatment in routine clinical care and is only available in research settings.
• The authors stressed that we need better, simple ways to measure and predict who will not respond. That would allow clinicians to move people sooner to other treatments that might help.
• Because the idea of treatment resistance is not well defined and studies vary, the review warns that current findings are preliminary. Clinicians must weigh risks and benefits for each person before trying second-line treatments.

Topics

Posttraumatic Stress Disorder Research Traumatic Brain Injury Research Treatment of Major Depression

Categories

Clinical Psychology Psychology Social Sciences

Tags

Anxiety Biology Clinical psychology Context (archaeology) Epistemology Exposure therapy Medicine Neurology Operationalization Paleontology Philosophy Psychiatry Psychological intervention Psychology Psychopharmacology Psychotherapist

Substances

Ketamine MDMA

Conditions & symptoms

Anxiety Depression PTSD Anxiety or worry Feeling disconnected from others Poor sleep Sadness or low mood