Les antidépresseurs dans le traitement de l’état de stress post-traumatique

Abstract

Posttraumatic stress disorder (PTSD) can be a prevalent, often chronic and disabling condition with major consequences for the individual and society. Diverse therapeutic approaches made the object of controlled and randomized studies: the pharmacological approach, the psychotherapic approach (essentially cognitivobehavioral), and the approaches combining pharmacology and psychotherapy. This article tries to review the available empirical data on antidepressant approaches to PTSD (selective serotonin re-uptake inhibitors, monoamine-oxydase inhibitors, tricyclic antidepressants, serotonin-norepinephrine re-uptake inhibitor) and to provide some recommendations for clinical practice. Although a comprehensive search of PubMed/Medline databases revealed a great number of case reports and open-label trials, we decided to focus primarily on evidence obtained from randomized controlled trials to determine the most effective antidepressant treatments for PTSD. Antidepressant pharmacotherapy seems to have positive effect on certain symptoms of PTSD but their short-term efficacy is partial and there remains unknown data on their long-term effectiveness. The available data supports antidepressant medication as the first-line pharmacotherapy for PTSD, with selective serotonin re-uptake inhibitors monotherapy having the strongest body of empirical support. Other potential options include, serotonin-norepinephrine re-uptake inhibitor, selective alpha-2 presynaptic serotoninergic inhibitors, monoamine-oxydase inhibitors or tricyclic antidepressants, and the combination with other pharmacotherapy in refractory PTSD cases. It seems to exist a certain consensus on the fact that the treatment should be continued for one prolonged length of time, exceeding largely the three months duration usually used in the controlled and randomized studies. A 12-month treatment seems indicated in chronic PTSD with residual symptoms.