SAN FRANCISCO — What medications tend to be prescribed for veterans diagnosed with post-traumatic stress disorder, and how has that changed over time?
A study in the Journal of Clinical Psychiatry evaluated longitudinal prescription practice trends for patients diagnosed with PTSD. Included was a national cohort of VHA patients from 2009 to 2018.1
Researchers from the VA San Francisco Healthcare System and colleagues used ICD-9 and ICD-10 codes to determine diagnoses and came up with a study group of 1.4 million VHA patients diagnosed with PTSD. Excluded were those who were diagnosed with bipolar or psychotic spectrum disorder.
Beginning in the year of their first PTSD diagnosis, veterans were included in the analytic sample for each year that they were active in VHA care. As part of that, outpatient prescription records were examined from 2009 to 2018 for medications that are commonly used as recommended for PTSD, including selective serotonin reuptake inhibitors [SSRIs] and serotonin-norepinephrine reuptake inhibitors [SNRIs]).
Researchers also gathered data on second-line/adjunctive medications, (i.e., atypical antipsychotics [AAPs], mirtazapine, prazosin, trazodone, tricyclic antidepressants and non-benzodiazepine hypnotics—medications for PTSD. Also assessed were benzodiazepine prescriptions.
Results indicate that, from 2009 to 2018, the percentage of VHA patients who received at least one of those recommended or second-line/adjunctive medications for PTSD in a calendar year declined by 9.0% (absolute change). The authors reported that the largest absolute change in rates of prescribing for medication classes over the last decade was documented for SSRIs (-12.3%) and SNRIs (+6.4%). At the same time, AAP use decreased 5.4% from 2009 to 2018, with most of the change (-4.3%) occurring from 2009 to 2013.
“Consistent with clinical practice guidelines, SSRIs/SNRIs were the most common prescriptions for patients in the current study,” the authors wrote. “Reductions in the percentage of patients receiving PTSD medications may reflect concerns regarding effectiveness, adverse side effects, increases in access to evidence-based psychotherapy for PTSD and/or symptom improvement such that medication was no longer needed.”
- Holder N, Woods A, Neylan TC, Maguen S, Seal KH, Bernardy N, Wiechers I, Ryder A, Urbieta AM, Cohen BE. Trends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study. J Clin Psychiatry. 2021 May 4;82(3):20m13522. doi: 10.4088/JCP.20m13522. PMID: 34004087.
