Deborah Brauser

July 11, 2013

EDINBURGH, Scotland — Eye movement desensitization and reprocessing (EMDR) may be a more efficacious treatment for patients with posttraumatic stress disorder (PTSD) than antidepressant medication, new research suggests.

A small, randomized trial of male survivors of the ongoing war in Pakistan with clinically diagnosed PTSD found that after 6 weeks, 90% of those who received weekly EMDR therapy showed treatment response.

The EMDR group also had a significantly greater overall drop in symptom severity scores compared with those who received daily 20-mg doses of the selective serotonin reuptake inhibitor (SSRI) paroxetine.

"We were very interested in the response rates between these 2 therapies," lead author Asad Ullah Jan, from the Armed Forces Institute of Mental Health Rawalpindi, in Pakistan, told Medscape Medical News.

"And we found that EMDR, which is a psychological therapy, was far superior to paroxetine. It has just been marvelous for us," said Dr. Jan.

The investigators note that although both are "widely accepted evidence-based interventions found to be efficacious in patients with PTSD," this is one of the first studies to compare the 2 interventions among survivors of war trauma.

The results were presented here at the International Congress of the Royal College of Psychiatrists (RCPsych) 2013.

Greater Symptom Reduction

For this study, 60 male survivors of war trauma presenting with PTSD were enrolled at the National University of Sciences and Technology (NUST) Centre for Trauma Research and Psychosocial Interventions in Pakistan.

Half were randomly assigned to receive weekly EMDR sessions, whereas the other half were randomly assigned to received paroxetine 20 mg daily. Each treatment group of 30 men included 7 with moderate PTSD and 23 with severe PTSD.

The military version of the PTSD checklist (PCL-M) was administered at baseline and 6 weeks after treatment to measure response and change in symptom severity. Treatment response was defined as a decrease of at least 20 points on the PCL-M.

Results showed that 90% of the EMDR group had a treatment response vs 36% of the paroxetine group.

In addition, the participants receiving EMDR had a significantly greater overall decrease in PCL-M symptom scores than those receiving paroxetine (P < .0001).

No Side Effects

Stratification of PTSD classification after treatment showed that 9 members of the EMDR group had their status lowered to "mild" (with all showing a treatment response). Of the remaining group members, 19 were considered "moderate" (with all but 1 showing a treatment response), and only 2 were considered "severe."

For the paroxetine group, after treatment, 23 members were classified as "moderate" (with only 10 showing a treatment response), and 7 were considered "severe."

Dr. Asad Ullah Jan

Dr. Jan noted that in Pakistan, all treatments, including medications, are free of charge. "But EMDR is becoming more acceptable, especially because it has no side effects."

"This is a therapy where we have to make the patient go through the same trauma while applying focused techniques. So they get anxious, and it's not enjoyable. But after, they feel much better," he said.

"And many of these patients were able to return to work, which was a big achievement for us."

He added that the investigators have continued to follow the study participants for the past 6 months to 1 year and hope to report the follow-up data soon.

"Straightforward"

"Although this study had fairly small numbers, it was interesting," Douglas Gee, MBChB, MRCPsych, medical director and consultant psychiatrist at the Humber Mental Health Teaching NHS Foundation Trust in the city of Hull, United Kingdom, told Medscape Medical News.

Dr. Gee, who was not involved with this research, added that he wished the investigators had compared EMDR to another psychological treatment.

"And I would have liked to have seen even more information. But overall, it seems to be very good and straightforward," he said.

International Congress of the Royal College of Psychiatrists (RCPsych) 2013. Poster 65. Presented July 3, 2013.

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