Post-traumatic stress disorder treatable in primary care

Post-traumatic stress disorder (PTSD) can be effectively treated in primary-care clinics, suggests a large national study. The finding hints at new opportunities to expand access to care for millions of Americans. 

“Only one-third of patients with PTSD receive specialty mental health care,” said Dr. John Fortney, the lead author and professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. “Improving access to proven, lifesaving treatments within primary care settings can get more patients on the road to recovery.” 

The study, published Oct. 15 in JAMA Psychiatry, compared two PTSD treatments: brief, trauma-focused psychotherapy known as Written Exposure Therapy and selective serotonin reuptake inhibitors, or SSRIs, medications usually prescribed for depression.  

Researchers enrolled 700 participants from seven Federally Qualified Health Centers and eight Department of Veterans Affairs Medical Centers across 11 states. It was one of the largest studies of its kind.  

At the beginning of the trial, patients had severe PTSD symptoms. From April 2021 to June 2024, patients were randomly assigned to receive either Written Exposure Therapy or an SSRI. After four months, patients in both treatment groups experienced a clinically significant decline in symptoms, with no difference in outcomes between the groups. 

For patients who did not respond to an initial SSRI treatment, the study compared adding Written Exposure Therapy or switching to a different type of medication called serotonin-norepinephrine reuptake inhibitors (SNRIs). Those switched to an SNRI had better outcomes than those whose SSRI treatment was augmented with therapy.  

“These findings suggest primary-care providers can deliver proven PTSD treatments that improve patient outcomes,” said Fortney. “We hope this approach can help reach patients who would otherwise not receive effective care.” 

The study also highlighted that engaging patients is a common challenge in PTSD treatment. Medication was somewhat easier for patients to complete than Written Exposure Therapy, but most patients in both groups completed a full treatment course. The authors said supportive approaches like collaborative care (integrating mental health with general medical services) or motivational coaching might help more patients stick with therapy. 

The trial was funded by a grant from the Patient-Centered Outcomes Research Institute. The researchers' conflict-of-interest statement is available in the journal publication. 

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