بهبود خشم در یک هفته اثرات سرترالین و دارونما در PTSD را پیش بینی می کند

In previous work we demonstrated an early, robust and sustained effect for sertraline vs placebo on irritability and anger in subjects with PTSD. In this report, we explore the same dataset to assess whether a clinician might usefully predict ultimate response to sertraline, on the basis of its effect upon anger after one week. Three hundred and eighteen subjects were assessed. Outcome was measured by whether or not the score was reduced by at least 50% from baseline. Ordinary least squares regression was used to estimate the effects of change in anger at one week. Logistic regression was applied to estimate the effects on odds of a 50% drop in score. Cut points were developed for one-week change scores on anger for sertraline and placebo. The best cut point was selected as predictive of non-response, i.e. a cue suggesting that treatment switch would be in order. An increase in anger of 30% at one-week best predicted the likelihood of not responding to treatment in both the drug and placebo groups. Twenty-five percent of all non-responders were incorrectly identified, while only 7% of all improvers were incorrectly categorized as non-responders using this cutoff. Our findings imply that, for patients similar to those in this study, an increase in anger after one week of treatment might be one factor to consider when making a decision about continuation of the medication.

In a study which looked at the effects of sertraline and placebo on individual symptoms of PTSD, we noted a broad-spectrum effect on practically all symptoms, with notable improvement of irritability/anger after one week, which was sustained throughout the remaining period of treatment. The magnitude of this change was significantly greater for sertraline than placebo at every visit, starting at week one. In further exploring the early improvement on anger, we found it explained some of the subsequent improvements in other symptoms (Davidson et al., 2002). The robust nature of this finding led us to ask whether the early changes in anxiety/irritability could perhaps serve as a predictor of likely response or non-response over the ensuing weeks. We therefore present a report which assesses the importance of early change in anger after one week of treatment. In particular, we wish to know whether, on the basis of change in anger at one week, the clinician could determine whether or not the likelihood of an unsuccessful outcome was strong enough that a change in treatment might be considered. In other words, we are concerned mostly with early detection of non-response at 12 weeks, defined as a reduction of 50% or more in PTSD symptoms.