Abstract

Background. Unlike civilian post-traumatic stress disorder (PTSD), the efficacy of sertraline for the treatment of combat-related PTSD has not yet been proven. The present study aimed to evaluate the clinical efficacy of sertraline against combat-related PTSD in a randomized, double-blind, placebo-controlled trial. Method. Seventy Iranian veterans of the Iran-Iraq war who met the DSM-IV criteria for diagnosis of PTSD were randomized to receive either flexibly dosed sertraline (50-200 mg/day) (n = 35, completers = 32) or placebo (n = 35, completers = 30) for 10 weeks. Efficacy was evaluated by the Impact of Event Scale - Revised (IES-R) and the Clinical Global Impression scale - Severity (CGI-S) and Improvement (CGI-I) ratings. Responder criteria were defined as a >= 30 reduction in the IES-R total score plus a CGI-I rating of 'much' or 'very much' improved. Results. On both intention-to-treat (ITT) and per protocol (completer) methods of analysis, the mean reductions in the IES-R total and subscale (re-experiencing/intrusion, avoidance/numbing and hyperarousal) scores (p<0.001) and also in the CGI-S score (p<0.01) were significantly greater in the sertraline group than in the placebo group. For the CGI-I, the mean endpoint score was significantly lower in the sertraline group than in the placebo group (p <= 0.001). The number of responders in the sertraline group was significantly higher than in the placebo group (44 v. 3, p <= 0.001). Sertraline was well tolerated, with a 6 discontinuation rate as a result of adverse reactions. Conclusions. The results of this study suggest that sertraline can be an effective, safe and tolerable treatment for combat-related PTSD in Iranian veterans.