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A comparative study of fluoxetine, moclobemide, and tianeptine in the treatment of posttraumatic stress disorder following an earthquake

Published online by Cambridge University Press:  16 April 2020

E. Önder ,
Ü. Tural  and
T. Aker
E. Önder
Affiliation:
Center for Psychological Trauma, Medical School of Kocaeli University, Kocaeli, Turkey
Ü. Tural*
Affiliation:
Department of Psychiatry, Medical School of Kocaeli University, Kocaeli, Turkey
T. Aker
Affiliation:
Center for Psychological Trauma, Medical School of Kocaeli University, Kocaeli, Turkey
*
*Corresponding author. Present address: Kocaeli Üniversitesi Tıp Fakültesi Psikiyatri Bölümü, Derince-İzmit, Kocaeli 41900, Turkey. Tel.: +90 262 233 5981x1708; fax: +90 262 233 5461. E-mail addresses: turalu@hotmail.com (Ü. Tural).
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Abstract.

Purpose

Although antidepressant drugs have been proven as an effective treatment for posttraumatic stress disorder (PTSD), there are few comparative studies of antidepressants that are acting on different neurotransmitters. The main aim of this study is to compare the efficacy of different class of antidepressant drugs on the PTSD.

Subjects/materials and methods. –

In this open label study, the patients who met DSM-IV criteria for PTSD were randomly assigned to flexible doses of fluoxetine, moclobemide, or tianeptine. After the first assessment, consecutive assessments were performed at the end of weeks 2, 4, 8, and 12 using clinician administered PTSD scale (CAPS) and Clinical Global Impression of Severity (CGI-S). Changes in the total score of CAPS and sub-scale scores of symptom clusters (re-experience, avoidance, and hyperarousal) were the main output of efficacy. All statistics were based on intention-to-treat and last-observation-carried-forward (LOCF) principles.

Results.

Thirty-eight patients were assigned to fluoxetine, 35 patients were assigned to moclobemide, and 30 patients were assigned to tianeptine group. Gender distributions and mean ages of the treatment groups were not significantly different. Drop-out rates due to an adverse events or unknown reasons were not significantly different among fluoxetine (18.4%), moclobemide (14.3%), and tianeptine (20.0%) groups. All three treatments has led to a significant improvement in PTSD severity assessed with CAPS total score (ANOVA P < 0.001). Similarly, total scores of re-experiencing, avoidance, and hyperarousal clusters that are subscales of CAPS were significantly reduced by all three treatments (with ANOVA all P values < 0.001). There was not significant difference in terms of treatment effect between three groups.

Discussion. –

Treatment groups showed very similar improvement on all ratings scales. The findings support that fluoxetine, moclobemide, and tianeptine are all effective in the treatment of PTSD. Different mechanisms of action for these antidepressant drugs might result in the same common neurochemical end point. However, further studies using different classes of antidepressant drugs are needed.

Keywords

Posttraumatic stress disorderNatural disastersFluoxetineMoclobemideTianeptineTreatment
Type
Original report
Information
European Psychiatry , Volume 21 , Issue 3 , April 2006 , pp. 174 - 179
Copyright
Copyright © European Psychiatric Association 2006

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