Key Takeaways

From the Authors As published in the article
  1. Although trauma-focused therapies are the gold standard treatment for PTSD, there is some evidence to suggest that the presence of depression in patients with PTSD is associated with poorer treatment response to these treatments.
  2. For patients with PTSD with comorbid major depressive disorder, clinicians should consider use of a non-trauma-focused therapy such as interpersonal psychotherapy.
Extended Takeaways
  1. In this veteran sample, prolonged exposure had substantially poorer retention overall than interpersonal psychotherapy, with 52.9% versus 22.4% completing fewer than 8 sessions; patients in interpersonal psychotherapy also completed more sessions on average (9.8 vs 7.1, t=3.66, P<.001).
  2. Among veterans without MDD, noncompletion was markedly higher in prolonged exposure than in interpersonal psychotherapy (63% vs 18%), and prolonged exposure patients in this subgroup completed fewer sessions on average (6.2 vs 10.2, P<.001).
  3. Within prolonged exposure, comorbid MDD was linked to worse PTSD outcomes despite similar retention, including significantly less improvement in CAPS-5 symptom severity (t30=−2.16, P =.04) and lower rates of both loss of PTSD diagnosis (χ2 =3.86, P =.049) and remission (χ2 =4.57, P =.033).
  4. For veterans with MDD, interpersonal psychotherapy showed a clinically meaningful but nonsignificant advantage over prolonged exposure on PTSD response, with response rates of 48% versus 19% and a trend toward greater CAPS-5 improvement (t = 1.90, P = .07).
  5. Depression symptom change did not distinguish interpersonal psychotherapy from prolonged exposure: PHQ-9 improvement was not significantly different between treatments in veterans with or without MDD, suggesting any apparent advantage of interpersonal psychotherapy in comorbid MDD was specific to PTSD outcomes in this study.
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