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Posttraumatic Stress Disorder and Quality of Life: Results Across 64 Weeks of Sertraline Treatment
Mark H. Rapaport, M.D.; Jean Endicott, Ph.D.; and Cathryn M. Clary, M.D.
Objective: The goal of the current study was to characterize the quality of life (QOL) and functional impairment associated with posttraumatic stress disorder (PTSD) and to report the QOL/functional response over the course of long-term treatment.
Method: QOL and psychosocial functioning were analyzed in 359 randomly assigned patients across a 3-phase study of sertraline in the treatment of chronic DSM-III-R-defined PTSD: (1) 12 weeks of double-blind, placebo-controlled acute treatment with sertraline in flexible doses of 50 to 200 mg/day, (2) 24 weeks of open-label continuation treatment with sertraline among all study completers (regardless of initial study drug assignment or endpoint responder status), and (3) 28 weeks of double-blind, placebo-controlled maintenance treatment with sertraline in continuation phase responders. Assessments included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), emotional role functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), as well as the occupational and social functioning items on the Clinician-Administered PTSD Scale, Part 2 (CAPS-2).
Results: At acute phase baseline, QOL was significantly impaired as reflected by a mean Q-LES-Q score of 56% of the total possible score and a CAPS-2 social/occupational impairment composite score of 4.4. Sertraline treatment was associated with marked improvement on all QOL/functional measurements: at the end of the acute treatment phase, 58% of responders on treatment with sertraline had achieved Q-LES-Q total scores within 10% of community norms. Twenty-four weeks of continuation treatment led to an additional 20% improvement in QOL and measures of functioning. Double-blind discontinuation of sertraline resulted in recurrence of PTSD symptoms and a worsening of QOL and functional measures, although the degree of exacerbation in symptomatology and psychosocial impairment was notably less than at study entry.
Conclusion: Sertraline treatment of chronic PTSD is associated with rapid improvement in quality of life that is progressive and sustained over the course of more than 1 year of treatment.
(J Clin Psychiatry 2002;63:59-65)
Received June 29, 2001; accepted Oct. 29, 2001. From the Department of Psychiatry, University of California, San Diego, and the San Diego Veterans' Affairs Healthcare System, San Diego, Calif. (Dr. Rapaport); the College of Physicians and Surgeons, Columbia University, New York, N.Y., (Dr. Endicott); and Pfizer, Inc., New York, N.Y. (Dr. Clary).
Financial support: Research was funded by Pfizer, Inc., New York, N.Y.
Financial disclosure: Dr. Rapaport is a consultant for, has received grant/research support and honoraria from, and is on the speakers or advisory boards for Pfizer, Inc. Dr. Endicott is a consultant for Pfizer, Abbott, Eli Lilly, Boehringer Ingelheim, and GlaxoSmithKline, and is on the speakers or advisory boards of Eli Lilly and Pfizer. Dr. Clary is employed by and is a major stock shareholder of Pfizer, Inc.
Reprint requests to: Mark H. Rapaport, M.D., Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Dr., Suite 2243, La Jolla, CA 92037.