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Forman-Hoffman V, Middleton JC, Feltner C, et al. Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 May. (Comparative Effectiveness Review, No. 207.)

Cover of Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update

Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update [Internet].

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Figure 26 is titled “Results of network meta-analysis comparing improvement in PTSD symptoms (change in CAPS total score).” The figure displays 12 forest plots of studies that completed head to head comparisons of PTSD medications to determine each medications effectiveness in improving PTSD symptoms based on CAPS. Negative change scores favor Drug A and positive change scores favor Drug B. The first forest plot compares buproprion (Drug A) versus other drugs (Drug B); buproprion versus citalopram (−0.06, 95% CI, −1.00 to 0.88); buproprion versus desipramine (0.83, 95% CI, −0.06 to 1.73); buproprion versus divalproex (0.16, 95% CI, −0.73 to 1.04); buproprion versus fluoxetine (0.50, 95% CI, −0.29 to 1.29); buproprion versus olanzapine (1.25, 95% CI, 0.26 to 2.24); buproprion versus paroxetine (0.69, 95% CI, −0.09 to 1.48); buproprion versus prazosin (0.72, 95% CI, −0.14 to 1.59); buproprion versus risperidone (0.45, 95% CI, −0.35 to 1.25); buproprion versus sertraline (0.42, 95% CI, −0.37 to 1.20); buproprion versus tiagabine (0.24, 95% CI, −0.58 to 1.06); buproprion versus topiramate (1.23, 95% CI, 0.37 to 2.08); buproprion versus venlafaxine (0.49, 95% CI, −0.29 to 1.28). The second forest plot compares citalopram (Drug A) to other drugs (Drug B); citalopram versus desipramine (0.89, 95% CI, 0.20 to 1.58); citalopram versus divalproex (0.21, 95% CI, −0.47 to 0.90); citalopram versus fluoxetine (0.56, 95% CI, 0.00 to 1.11); citalopram versus olanzapine (1.31, 95% CI, 0.50 to 2.12); citalopram versus paroxetine (0.75, 95% CI, 0.20 to 1.30); citalopram versus prazosin (0.78, 95% CI, 0.13 to 1.43); citalopram versus risperidone (0.51, 95% CI, −0.06 to 1.08); citalopram versus sertraline (0.47, 95% CI, −0.05 to 1.00); citalopram versus tiagabine (0.29, 95% CI, −0.30 to 0.89); citalopram versus topiramate (1.28, 95% CI, 0.64 to 1.93); citalopram versus venlafaxine (0.55, 95% CI, 0.01 to 1.10). The third forest plot compares desipramine (Drug A) to other drugs (Drug B); desipramine versus divalproex (−0.68, 95% CI, −1.29 to −0.07); desipramine versus fluoxetine (−0.33, 95% CI, −0.80 to 0.13); desipramine versus olanzapine (0.42, 95% CI, −0.34 to 1.17); desipramine versus paroxetine (−0.14, 95% CI, −0.56 to 0.28); desipramine versus prazosin (−0.11, 95% CI, −0.70 to 0.47); desipramine versus risperidone (−0.38, 95% CI, −0.86 to 0.10); desipramine versus sertraline (−0.42, 95% CI, −0.88 to 0.04); desipramine versus tiagabine (−0.60, 95% CI, −1.11 to −0.09); desipramine versus topiramate (0.39, 95% CI, −0.18 to 0.96); desipramine versus venlafaxine (−0.34, 95% CI, −0.81 to 0.12). The fourth forest plot compares divalproex (Drug A) to other drugs (Drug B); divalproex versus fluoxetine (0.35, 95% CI, −0.11 to 0.80); divalproex versus olanzapine (1.09, 95% CI, 0.35 to 1.84); divalproex versus paroxetine (0.54, 95% CI, 0.09 to 0.98); divalproex versus prazosin (0.57, 95% CI, 0.00 to 1.14); divalproex versus risperidone (0.30, 95% CI, −0.17 to 0.76); divalproex versus sertraline (0.26, 95% CI, −0.18 to 0.70); divalproex versus tiagabine (0.08, 95% CI, −0.42 to 0.58); divalproex versus topiramate (1.07, 95% CI, 0.51 to 1.63); divalproex versus venlafaxine (0.34, 95% CI, −0.11 to 0.79). The fifth forest plot compares fluoxetine (Drug A) to other drugs (Drug B); fluoxetine versus olanzapine (0.75, 95% CI, 0.11 to 1.38); fluoxetine versus paroxetine (0.19, 95% CI, −0.02 to 0.40); fluoxetine versus prazosin (0.22, 95% CI, −0.19 to 0.63); fluoxetine versus risperidone (−0.05, 95% CI, −0.30 to 0.20); fluoxetine versus sertraline (−0.09, 95% CI, −0.28 to 0.11); fluoxetine versus tiagabine (−0.26, 95% CI, −0.57 to 0.04); fluoxetine versus topiramate (0.72, 95% CI, 0.33 to 1.12); fluoxetine versus venlafaxine (−0.01, 95% CI, −0.22 to 0.20). The sixth forest plot compares olanzapine (Drug A) to other drugs (Drug B); olanzapine versus paroxetine (−0.56, 95% CI, −1.19 to 0.08); olanzapine versus prazosin (−0.53, 95% CI, −1.25 to 0.20); olanzapine versus risperidone (−0.80, 95% CI, −1.45 to −0.15); olanzapine versus sertraline (−0.84, 95% CI, −1.46 to −0.21); olanzapine versus tiagabine (−1.01, 95% CI, −1.68 to −0.34); olanzapine versus topiramate (−0.03, 95% CI, −0.74 to 0.69); olanzapine versus venlafaxine (−0.76, 95% CI, −1.39 to −0.12). The seventh forest plot compares paroxetine (Drug A) to other drugs (Drug B); paroxetine versus prazosin (0.03, 95% CI, −0.38 to 0.43); paroxetine versus risperidone (−0.24, 95% CI, −0.48 to 0.00); paroxetine versus sertraline (−0.28, 95% CI, −0.46 to −0.10); paroxetine versus tiagabine (−0.46, 95% CI, −0.75 to −0.16); paroxetine versus topiramate (0.53, 95% CI, 0.15 to 0.92); paroxetine versus venlafaxine (−0.20, 95% CI, −0.40 to 0.00). The eighth forest plot compares prazosin (Drug A) to other drugs (Drug B); prazosin versus risperidone (−0.27, 95% CI, −0.69 to 0.16); prazosin versus sertraline (−0.30, 95% CI, −0.70 to 0.09); prazosin versus tiagabine (−0.48, 95% CI, −0.94 to −0.02); prazosin versus topiramate (0.51, 95% CI, −0.02 to 1.03); prazosin versus venlafaxine (−0.23, 95% CI, −0.63 to 0.18). The ninth forest plot compares risperidone (Drug A) to other drugs (Drug B); risperidone versus sertraline (−0.04, 95% CI, −0.26 to 0.19); risperidone versus tiagabine (−0.21, 95% CI, −0.54 to 0.11); risperidone versus topiramate (0.77, 95% CI, 0.37 to 1.18); risperidone versus venlafaxine (0.04, 95% CI, −0.20 to 0.28). The tenth forest plot compares sertraline (Drug A) to other drugs (Drug B); sertraline versus tiagabine (−0.18, 95% CI, −0.46 to 0.10); sertraline versus topiramate (0.81, 95% CI, 0.43 to 1.19); sertraline versus venlafaxine (0.08, 95% CI, −0.08 to 0.24). The eleventh forest plot compares tiagabine (Drug A) to other drugs (Drug B); tiagabine versus topiramate (0.99, 95% CI, 0.55 to 1.12); tiagabine versus venlafaxine (0.26, 95% CI, −0.04 to 0.55). The twelfth forest plot compares topiramate (Drug A) to other drugs (Drug B); topiramate versus venlafaxine (−0.73, 95% CI, −1.12 to −0.34).
Figure 26 is titled “Results of network meta-analysis comparing improvement in PTSD symptoms (change in CAPS total score).” The figure displays 12 forest plots of studies that completed head to head comparisons of PTSD medications to determine each medications effectiveness in improving PTSD symptoms based on CAPS. Negative change scores favor Drug A and positive change scores favor Drug B. The first forest plot compares buproprion (Drug A) versus other drugs (Drug B); buproprion versus citalopram (−0.06, 95% CI, −1.00 to 0.88); buproprion versus desipramine (0.83, 95% CI, −0.06 to 1.73); buproprion versus divalproex (0.16, 95% CI, −0.73 to 1.04); buproprion versus fluoxetine (0.50, 95% CI, −0.29 to 1.29); buproprion versus olanzapine (1.25, 95% CI, 0.26 to 2.24); buproprion versus paroxetine (0.69, 95% CI, −0.09 to 1.48); buproprion versus prazosin (0.72, 95% CI, −0.14 to 1.59); buproprion versus risperidone (0.45, 95% CI, −0.35 to 1.25); buproprion versus sertraline (0.42, 95% CI, −0.37 to 1.20); buproprion versus tiagabine (0.24, 95% CI, −0.58 to 1.06); buproprion versus topiramate (1.23, 95% CI, 0.37 to 2.08); buproprion versus venlafaxine (0.49, 95% CI, −0.29 to 1.28). The second forest plot compares citalopram (Drug A) to other drugs (Drug B); citalopram versus desipramine (0.89, 95% CI, 0.20 to 1.58); citalopram versus divalproex (0.21, 95% CI, −0.47 to 0.90); citalopram versus fluoxetine (0.56, 95% CI, 0.00 to 1.11); citalopram versus olanzapine (1.31, 95% CI, 0.50 to 2.12); citalopram versus paroxetine (0.75, 95% CI, 0.20 to 1.30); citalopram versus prazosin (0.78, 95% CI, 0.13 to 1.43); citalopram versus risperidone (0.51, 95% CI, −0.06 to 1.08); citalopram versus sertraline (0.47, 95% CI, −0.05 to 1.00); citalopram versus tiagabine (0.29, 95% CI, −0.30 to 0.89); citalopram versus topiramate (1.28, 95% CI, 0.64 to 1.93); citalopram versus venlafaxine (0.55, 95% CI, 0.01 to 1.10). The third forest plot compares desipramine (Drug A) to other drugs (Drug B); desipramine versus divalproex (−0.68, 95% CI, −1.29 to −0.07); desipramine versus fluoxetine (−0.33, 95% CI, −0.80 to 0.13); desipramine versus olanzapine (0.42, 95% CI, −0.34 to 1.17); desipramine versus paroxetine (−0.14, 95% CI, −0.56 to 0.28); desipramine versus prazosin (−0.11, 95% CI, −0.70 to 0.47); desipramine versus risperidone (−0.38, 95% CI, −0.86 to 0.10); desipramine versus sertraline (−0.42, 95% CI, −0.88 to 0.04); desipramine versus tiagabine (−0.60, 95% CI, −1.11 to −0.09); desipramine versus topiramate (0.39, 95% CI, −0.18 to 0.96); desipramine versus venlafaxine (−0.34, 95% CI, −0.81 to 0.12). The fourth forest plot compares divalproex (Drug A) to other drugs (Drug B); divalproex versus fluoxetine (0.35, 95% CI, −0.11 to 0.80); divalproex versus olanzapine (1.09, 95% CI, 0.35 to 1.84); divalproex versus paroxetine (0.54, 95% CI, 0.09 to 0.98); divalproex versus prazosin (0.57, 95% CI, 0.00 to 1.14); divalproex versus risperidone (0.30, 95% CI, −0.17 to 0.76); divalproex versus sertraline (0.26, 95% CI, −0.18 to 0.70); divalproex versus tiagabine (0.08, 95% CI, −0.42 to 0.58); divalproex versus topiramate (1.07, 95% CI, 0.51 to 1.63); divalproex versus venlafaxine (0.34, 95% CI, −0.11 to 0.79). The fifth forest plot compares fluoxetine (Drug A) to other drugs (Drug B); fluoxetine versus olanzapine (0.75, 95% CI, 0.11 to 1.38); fluoxetine versus paroxetine (0.19, 95% CI, −0.02 to 0.40); fluoxetine versus prazosin (0.22, 95% CI, −0.19 to 0.63); fluoxetine versus risperidone (−0.05, 95% CI, −0.30 to 0.20); fluoxetine versus sertraline (−0.09, 95% CI, −0.28 to 0.11); fluoxetine versus tiagabine (−0.26, 95% CI, −0.57 to 0.04); fluoxetine versus topiramate (0.72, 95% CI, 0.33 to 1.12); fluoxetine versus venlafaxine (−0.01, 95% CI, −0.22 to 0.20). The sixth forest plot compares olanzapine (Drug A) to other drugs (Drug B); olanzapine versus paroxetine (−0.56, 95% CI, −1.19 to 0.08); olanzapine versus prazosin (−0.53, 95% CI, −1.25 to 0.20); olanzapine versus risperidone (−0.80, 95% CI, −1.45 to −0.15); olanzapine versus sertraline (−0.84, 95% CI, −1.46 to −0.21); olanzapine versus tiagabine (−1.01, 95% CI, −1.68 to −0.34); olanzapine versus topiramate (−0.03, 95% CI, −0.74 to 0.69); olanzapine versus venlafaxine (−0.76, 95% CI, −1.39 to −0.12). The seventh forest plot compares paroxetine (Drug A) to other drugs (Drug B); paroxetine versus prazosin (0.03, 95% CI, −0.38 to 0.43); paroxetine versus risperidone (−0.24, 95% CI, −0.48 to 0.00); paroxetine versus sertraline (−0.28, 95% CI, −0.46 to −0.10); paroxetine versus tiagabine (−0.46, 95% CI, −0.75 to −0.16); paroxetine versus topiramate (0.53, 95% CI, 0.15 to 0.92); paroxetine versus venlafaxine (−0.20, 95% CI, −0.40 to 0.00). The eighth forest plot compares prazosin (Drug A) to other drugs (Drug B); prazosin versus risperidone (−0.27, 95% CI, −0.69 to 0.16); prazosin versus sertraline (−0.30, 95% CI, −0.70 to 0.09); prazosin versus tiagabine (−0.48, 95% CI, −0.94 to −0.02); prazosin versus topiramate (0.51, 95% CI, −0.02 to 1.03); prazosin versus venlafaxine (−0.23, 95% CI, −0.63 to 0.18). The ninth forest plot compares risperidone (Drug A) to other drugs (Drug B); risperidone versus sertraline (−0.04, 95% CI, −0.26 to 0.19); risperidone versus tiagabine (−0.21, 95% CI, −0.54 to 0.11); risperidone versus topiramate (0.77, 95% CI, 0.37 to 1.18); risperidone versus venlafaxine (0.04, 95% CI, −0.20 to 0.28). The tenth forest plot compares sertraline (Drug A) to other drugs (Drug B); sertraline versus tiagabine (−0.18, 95% CI, −0.46 to 0.10); sertraline versus topiramate (0.81, 95% CI, 0.43 to 1.19); sertraline versus venlafaxine (0.08, 95% CI, −0.08 to 0.24). The eleventh forest plot compares tiagabine (Drug A) to other drugs (Drug B); tiagabine versus topiramate (0.99, 95% CI, 0.55 to 1.12); tiagabine versus venlafaxine (0.26, 95% CI, −0.04 to 0.55). The twelfth forest plot compares topiramate (Drug A) to other drugs (Drug B); topiramate versus venlafaxine (−0.73, 95% CI, −1.12 to −0.34).

Figure 26Results of network meta-analysis comparing improvement in PTSD symptoms (change in CAPS total score)

CAPS = Clinician-Administered PTSD Scale; N = number; CI = confidence interval; PTSD = posttraumatic stress disorder; SMD = standardized mean difference.

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