Shrinks In Sneakers

Tag: PTSD treatment

  • Brexpiprazole + Sertraline: A New Hope for PTSD Treatment

    Brexpiprazole + Sertraline: A New Hope for PTSD Treatment

    We’ve all seen it: PTSD that won’t budge. Patients try sertraline or paroxetine—the so-called “gold standards”—and walk away with little more than side effects and a sense of failure.

    Enter a new contender: brexpiprazole + sertraline.

    A recent Phase 3 randomized controlled trial might finally offer something real for those stuck in the PTSD trenches.

    🚨 The Results

    In a study across 86 sites with over 550 adults, adding brexpiprazole (2–3 mg) to sertraline (150 mg) led to a 5.6-point greater reduction on the CAPS‑5 (the gold-standard PTSD measure) compared to sertraline + placebo. That’s not a marginal win—it’s a clinically significant shift, especially in a treatment-resistant population.

    Responder rates tell the story even clearer:

    • 68.5% of patients on the combo had ≥30% reduction in symptoms
    • Compared to 48.2% on sertraline alone
    • That’s a +20% absolute response rate boost

    And the improvements weren’t just short-lived. Benefits held through 12 weeks, even during a post-treatment observation period. No relapse, no rebound—just stability.

    🧩 More Than Symptom Checklists

    It wasn’t just about PTSD symptoms. This combo also:

    • Improved psychosocial functioning (B-IPF scores)
    • Reduced anxiety and depression (HADS)
    • Lowered global illness severity (CGI-S)
    • Helped with all symptom clusters, including reexperiencing, avoidance, and hyperarousal

    That’s rare. Most meds in psychiatry hit one or two domains and leave the rest hanging. This one made a dent where it counts: function, resilience, and real-world relief.

    ⚠️ What About Side Effects?

    Brexpiprazole is still an atypical antipsychotic, so there’s baggage. But the trial data suggest it’s relatively well-tolerated:

    • Fatigue: 6.8%
    • Weight gain: 5.9%
    • Somnolence: 5.4%
    • Discontinuation due to AEs? Just 3.9%, vs 10.2% in placebo.

    No new safety signals. No psychosis worsening. Not perfect, but not the metabolic disaster zone we see with other agents.

    🚀 What’s Next?

    The FDA is reviewing this combo

    For those of us treating chronic PTSD, this may be a real tool—not just a shiny new molecule with good marketing.

    Until then, it’s worth paying attention. Because when sertraline alone doesn’t cut it—and we know it often doesn’t—this combo could offer a lifeline.

  • Why CBT Reigns as the Top Therapy for Mental Health

    Why CBT Reigns as the Top Therapy for Mental Health

    🧠💡 CBT Confirmed—Again: Landmark Meta-Analysis Reinforces Clinical Value Across Diagnoses
    A massive meta-analysis in JAMA Psychiatry (2025) reaffirms what many of us observe in day-to-day care: Cognitive Behavioral Therapy (CBT) is one of the most effective, versatile, and enduring treatments for adult psychiatric conditions.

    🔬 Study at a Glance

    • Pooled data from hundreds of RCTs
    • Assessed CBT’s efficacy across depression, anxiety disorders, PTSD, and eating disorders
    • Found significant, lasting effects across diagnostic categories
    • Highlighted condition-specific variation in effect sizes, but overall CBT consistently outperformed inactive controls

    📚 Real-World Relevance
    Imagine a patient with chronic panic disorder who’s failed two SSRI trials and prefers non-pharmacologic interventions. CBT remains a frontline solution—equally relevant for the young adult with bulimia or the veteran with PTSD. These aren’t just data points—they’re the cases we see every day.

    🔄 How Does CBT Stack Up Against Other Therapies?
    While the study primarily focused on CBT, it reinforces existing literature suggesting that CBT often matches or outperforms alternative modalities like psychodynamic therapy or interpersonal therapy in short-term efficacy—especially when structure, time-limited treatment, and measurable goals are critical.

    🛠 Implications for Clinical Practice
    ✅ Why prioritize CBT?

    • It’s highly adaptable
    • Supported across diverse populations
    • Scalable via group therapy, digital tools, and telehealth

    🚧 Barriers to Access:

    • Limited availability of trained therapists
    • Insurance coverage gaps
    • Patient preference for “talk therapy” without structure

    ✅ Strategies to Overcome Them:

    • Integrate CBT-informed principles into brief med management visits
    • Refer to digital CBT platforms when face-to-face access is limited
    • Advocate for reimbursement parity and expanded training programs

    📎 Bottom Line
    This study isn’t just academic—it’s a call to action. Prioritizing CBT in treatment planning can lead to better outcomes, broader reach, and more durable recovery. As clinicians, it’s on us to ensure our systems support its accessibility.

    📖 Full Article:
    https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2832696

  • The Dirty Little Secret They Won’t Tell You About Psychedelics

    The Dirty Little Secret They Won’t Tell You About Psychedelics

    It’s obvious to me, but I think the public, including many of our patients, remains unaware of a crucial truth: Psychedelics will not cure your depression, your PTSD, or your difficult life circumstances.

    There’s a growing wave of enthusiasm around psychedelics as miracle cures for mental health conditions, but the hard reality is that the evidence just doesn’t back it up—at least not yet. Even if you find yourself on the hopeful side, believing we desperately need alternatives to alleviate people’s suffering, the reported benefits of these substances have not been validated by large, rigorous, randomized controlled trials. The buzz around psychedelics often overshadows the fact that they lack the necessary scientific backing to support their mainstream use in treating complex mental health issues like depression or PTSD.

    Let’s not ignore the financial stakes here either: The people promoting these drugs stand to make billions of dollars. There’s a lot of money on the table, and many in the academic community are rallying behind these companies. But we should ask ourselves—are they doing so because of solid science or because of the potential financial windfall?

    These drugs have been around for decades, yet one consistent truth I’ve observed in every person I’ve known who’s used them is this: You must use them repeatedly, and they almost always experience a relapse of symptoms over time. There’s no permanent fix here, just a temporary reprieve, if even that.

    We can draw parallels with other treatments like ECT (electroconvulsive therapy) and ketamine. Both have shown promise in certain cases, but I’ve yet to see anyone cured by these treatments. We often perform maintenance ECT and maintenance ketamine therapy for this very reason. Just like psychedelics, they might offer temporary relief, but they don’t provide long-term solutions without ongoing interventions.

    I understand this may come off as cynical, but I’ve seen too many people fall for the hype, only to be disappointed later. People far more charismatic than me will try to convince you that psychedelics will cure everything that ails you—for a hefty price tag. Don’t buy into it without questioning the science and the motives behind the push.

  • PTSD by Any Other Name: Rethinking the Label to Break the Stigma

    PTSD by Any Other Name: Rethinking the Label to Break the Stigma

    An advocacy group has proposed changing the name of post-traumatic stress disorder (PTSD) to post-traumatic stress injury (PTSI) for inclusion in the DSM-5 TR. However, in November 2023, the APA steering committee rejected the proposal, citing insufficient evidence to support the change. Advocates argue that the term “disorder” is both imprecise and carries stigma, which can discourage people from seeking timely care. This delay or avoidance of care can lead to serious consequences, including suicide attempts. The term “disorder” has long been controversial in psychiatry, and I’ve always favored the use of “disease” to help distinguish between true disease processes and challenges of living. I also believe that people may be more likely to seek help if they view the issue as a disease or injury. While this change may not happen soon, maintaining open dialogue about how to encourage treatment is essential.