A Summary of Current Unmet Needs in the Treatment of Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a highly prevalent disorder with heterogeneous and burdensome symptoms across four symptom clusters: intrusion/re-experiencing, avoidance, negative cognitions and mood, and arousal and reactivity. For patients with PTSD, treatment options remain limited. The aim of this poster is to summarize current unmet needs in the treatment of PTSD.
US and international treatment guidelines recommend trauma-focused psychological interventions (such as cognitive behavioral therapy) as first-line treatment for PTSD, supported by evidence from clinical trials. In clinical practice, however, the use of trauma-focused psychotherapy can be limited by access difficulties for patients, and a lack of training/support for therapists.
The majority of treatment guidelines also recommend selective serotonin reuptake inhibitors (SSRIs) as first-line treatment for PTSD, if pharmacological treatment is indicated. Currently, there are few evidence-based medications, and only sertraline and paroxetine are FDA approved. Clinical trials support the use of SSRIs; however, effect sizes are modest, and many patients have inadequate response. For sertraline, efficacy results are inconsistent across randomized trials, particularly for the intrusion/re-experiencing cluster, and the effects of sertraline are more apparent on psychological rather than somatic symptoms. Polypharmacy (e.g., atypical antipsychotics, serotonin–norepinephrine reuptake inhibitors, benzodiazepines/sedatives, antihypertensive agents, mood stabilizers) is often used to address a broader range of PTSD symptoms, despite limited evidence for benefits and risks.
In conclusion, given the limitations of current treatments and the lack of pharmacotherapy approval for over two decades, there is an urgency to address unmet needs that remain in the treatment of PTSD.