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Daily Medical Update
Post-traumatic stress disorder
Saturday, June 06, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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The Cochrane Database of Systematic Reviews (2026) - Systematic Review and Meta-Analysis of RCTs
Key Findings
- SSRIs improved PTSD symptoms in 58% of participants versus 35% with placebo (RR 0.66; 95% CI 0.59-0.74).
- Treatment withdrawal due to adverse events increased with SSRIs versus placebo (RR 1.41; 95% CI 1.07-1.87), although absolute dropout remained 9%.
📋 Practice Implication: Use SSRIs as the default medication option when drug therapy is needed, reserve mirtazapine or amitriptyline for selected cases, and avoid assuming antipsychotics will improve core PTSD symptoms.
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Depression and Anxiety (2026) - Individual Participant Data Meta-Analysis
Key Findings
- Female sex increased odds of acute and persistent PTSD and MDD after trauma (OR range 1.48-2.14).
- Acute reexperiencing symptoms and greater acute MDD severity increased risk for persistent PTSD at follow-up (odds ratio 1.18 and odds ratio 1.14-1.17, respectively).
📋 Practice Implication: Intensify early follow-up after emergency or critical care trauma when patients present with depressive symptoms, reexperiencing, or other high-risk features rather than waiting for chronic PTSD to declare itself.
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Clinical Psychology & Psychotherapy (2025) - Systematic Review and Meta-Analysis
Key Findings
- EMDR delivered 3 months or more after trauma reduced pediatric PTSD symptoms versus waitlist/usual care with a large pooled effect (SMD 1.57; 95% CrI 0.07-3.21).
- EMDR versus trauma-focused CBT showed no significant difference in PTSD symptom improvement in two trials.
📋 Practice Implication: Offer EMDR as a legitimate pediatric treatment option, especially when trauma-focused CBT access is limited or family preference favors EMDR, while recognizing that cost-effectiveness evidence is still thin.
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BMC Psychiatry (2025) - Systematic Review and Meta-Analysis of RCTs
Key Findings
- Active interventions improved PTSD symptoms (SMD 0.86) and sleep disorder symptoms (SMD 1.06) versus placebo or supportive care.
- Acceptability did not worsen with active treatment versus controls (RR 1.08; 95% CI 0.92-1.26), and total sleep time did not improve significantly.
📋 Practice Implication: Treat insomnia and nightmares as part of the PTSD plan instead of deferring them, choosing psychotherapy or medication according to symptom pattern and patient subgroup.
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Prilozi (2026) - Systematic Review and Multilevel Meta-Analysis
Key Findings
- Adults with PTSD showed poorer verbal episodic and working memory versus trauma-exposed controls without PTSD.
- Memory performance was reduced and remained statistically significant after sensitivity analyses and trim-and-fill adjustment for possible publication bias.
📋 Practice Implication: Add cognitive screening and compensatory supports when PTSD patients report functional memory problems, because the deficits appear to extend beyond trauma exposure alone.
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Summary
Recent PTSD evidence supports SSRIs as the best-supported medication class, identifies early depressive and reexperiencing symptoms as markers of persistence, and favors active treatment for common sleep comorbidity and pediatric PTSD. Objective memory impairment also appears clinically meaningful beyond trauma exposure alone; because only four first-pass studies met the >=7 significance threshold, one lower-scoring study was included and future searches may need broader terms.
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