Value of Most Post-Traumatic Stress Treatments 'Uncertain'

All of the other pharmaceutical or behavioral treatments failed to reach that threshold, leaving the IOM team uncertain as to whether or not the therapies might be effective.

Much of that uncertainty was due to a preponderance of poorly conducted or incomplete trials, the experts said.

For example, many studies had participant dropout rates between 20 percent and 50 percent, making it nearly impossible for researchers to draw reliable conclusions.

In other cases, investigators weren't "blinded" as to which patients were getting a particular treatment or not, allowing bias to potentially creep into the results.

Furthermore, "the majority of the drug studies have been funded by the pharmaceutical manufacturers, and the majority of the psychotherapy studies have been conducted by the individuals who developed the techniques, or by their close collaborators," Berg noted. To help avoid bias, "We recommend that a broader range of investigators be supported to conduct studies that will replicate and confirm earlier studies," he said.

One expert wasn't surprised by the lack of consistent, quality data on PTSD treatments.

"PTSD does not take the same form in every person, and it doesn't have the same severity in every person," said Dr. Charles Goodstein, a clinical professor of psychiatry at New York University School of Medicine. "So, you're dealing with a very heterogeneous population and, moreover, the treatments for this population probably have to be tailor-made."

That assessment dovetails with the IOM report, which stressed the need for high-quality research on the effectiveness of treatments for particular types of patients. "These subpopulations include people with concurrent disorders such as substance abuse, depression, ethnic minorities and veterans with traumatic brain injuries," Berg said.

Conducting large, rigorous trials will cost money, but it could save the government many more dollars in the end, not to mention easing the burden on patients, Goodstein added.

"Why should people be subjected to forms of treatment that may not work?" he said. "Why should the government be paying money for treatments that don't work? Why should people be suffering with symptoms longer than they have to? These are all important questions, and that's really the bottom line of this report."

More information

Find out more about PTSD at the U.S. Department of Veterans Affairs.

SOURCES: Charles Goodstein, M.D., clinical professor, psychiatry, New York University School of Medicine, New York City; Oct. 18, 2007, Institute of Medicine teleconference with Alfred Berg, M.D., professor, family medicine, University of Washington School of Medicine, Seattle; and David Matchar, director of the Center for Clinical Health Policy Research, and professor, medicine, Duke University Medical Center, Durham, N.C.