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.Treatment of posttraumatic stress disorder with citalopram and psychodynamic psychotherapy: a double-blind, placebo-controlled trial.
Posttraumatic stress disorder (PTSD) is a debilitating and recurrent condition. In response to the dramatic increase in PTSD rates among returning military personnel, the Department of Defense initiated treatment guidelines and subsequently developed a four-stage treatment approach: acute, stabilization, resolution, and maintenance. These guidelines emphasize the use of psychotherapy to alleviate PTSD symptoms. Although clinical guidelines have shown promise, randomized, controlled trials have produced mixed results. In this study, we tested the efficacy of a treatment combining psychodynamic psychotherapy and citalopram. One hundred twenty-eight patients with DSM-IV PTSD were randomly assigned to receive 16 weeks of either citalopram (20 mg/day) and psychodynamic psychotherapy or psychodynamic psychotherapy alone. All patients received a single dose of citalopram during their first psychotherapy session and took their first dose of citalopram at home. During the first 4 weeks, citalopram was tapered and discontinued. Psychodynamic psychotherapy was delivered in individual sessions (n = 81) or in groups (n = 49). Symptoms were rated with the Clinician-Administered PTSD Scale (CAPS) at baseline, 4 weeks, 8 weeks, and 16 weeks. Compared with placebo, citalopram was associated with significantly greater symptom reduction at all posttreatment time points (p 0b46394aab