A Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder

Abstract

The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. Method: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003. Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adultonset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma.

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

“…One recent randomized clinical trial comparing EMDR versus fluoxetine found the psychotherapy intervention to be more efficacious among individuals with adult-onset trauma. Sustained reductions were found for both PTSD and depressive symptoms, with both treatments superior to pill placebo [172].…”

Prevalence and Significant Determinants of Post-traumatic Stress Disorder in a Large Sample of Patients with Multiple Sclerosis

“…In order to verify this hypothesis, our group is currently treating the MS patients affected by PTSD involved in the present study. More precisely, we are currently treating them with Eye Movement Desensitization and Reprocessing (one of the most efficient psychotherapy methods for the treatment of post-traumatic stress disorder together with Trauma-Focused Cognitive Behaviour Therapy), which has recently started to show a beneficial effect on the quality of sleep, anxiety, and depressive symptoms too (Raboni et al, 2006;van der Kolk et al, 2007).…”

Design, development and validity testing of the gang affiliation risk measure (GARM)

“…Violent relational experiences in childhood frequently result in symptoms of 'PTSD' or 'developmental trauma' (Steiner, Garcia, & Matthews, 1997;van der Kolk, 2007;Schmid, Petermann & Fegert, 2013, Ford & Courtois, 2013Treisman, 2017).…”