Impact of PTSD treatment on postconcussive symptoms in veterans: A comparison of sertraline, prolonged exposure, and their combination.

Many Veterans who served in Iraq and Afghanistan struggle with posttraumatic stress disorder (PTSD) and the effects of traumatic brain injuries (TBI). Some people with a history of TBI report a constellation of somatic, cognitive, and emotional complaints that are often referred to as postconcussive symptoms (PCS). Research suggests these symptoms may not be specific to TBI. This study examined the impact of PTSD treatment on PCS in combat Veterans seeking treatment for PTSD. As part of a larger randomized control trial, 198 Operation Iraqi Freedom, Operation Enduring Freedom, Operation New Dawn (OIF/OEF/OND) Veterans with PTSD received Prolonged Exposure Therapy, sertraline, or the combination. Potential deployment related TBI, PCS, PTSD and depression symptoms were assessed throughout treatment. Linear mixed models were used to predict PCS change over time across the full sample and treatment arms, and the association of change in PTSD and depression symptoms on PCS was also examined. Patterns of change for the full sample and the subsample of those who reported a head injury were examined. Results showed that PCS decreased with treatment. There were no significant differences across treatments. No significant differences were found in the pattern of symptom change based on TBI screening status. Shifts in PCS were predicted by change PTSD and depression. Results suggest that PCS reduced with PTSD treatment in this population and are related to shift in depression and PTSD severity, further supporting that reported PCS symptoms may be better understood as non-specific symptoms.

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Déclaration de conflit d'intérêts

Declaration of competing interest Disclosures: This work was supported by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command (MRMC; Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy, and Their Combination in OEF/OIF Combat Veterans with PTSD; Grant #W81XWH-11-1-0073); the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant #UL1TR000433). The views expressed in this article presentation are solely those of the author(s) and do not reflect an endorsement by or the official policy of the Department of Veterans Affairs, Department of Defense, or the U.S. Government, or the official views of the National Institutes of Health. The contents do not represent the views of the US Department of Veterans Affairs (DVA), Department of Defense (DOD), or the United States Government. Dr. Rauch receives support from Wounded Warrior Project (WWP), DVA, National Institute of Health (NIH), Woodruff Foundation, and DOD and royalties from Oxford University Press and American Psychological Association Press. In the past 3 years Dr. Simon reports receiving grants from the National Institutes of Health (NIH), U.S. Department of Defense, American Foundation for Suicide Prevention, Patient-Centered Outcomes Research Institute, Ananda Scientific and support from Cohen Veterans Network and MindMed; receiving personal fees from Vanda Pharmaceuticals, Praxis Therapeutics, Genomind, Bionomics Limited, BehavR LLC, Cerevel, Engrail Therapeutics Inc; receiving fees or royalties from Wiley (Deputy Editor Depression and Anxiety), Wolters Kluwyer (UpToDate) and APA Publishing (Textbook of Anxiety, Trauma and OCD Related Disorders, 2020); and having spousal stock from G1 Therapeutics and Zentalis outside the submitted work. ClinicalTrials.gov: NCT01524133.