Fluoxetine v . placebo in prevention of relapse in post - traumatic stress disorder

Declaration of interest Thiswork was sponsoredby Eli Lilly & Co. Post-traumatic stress disorder (PTSD) is a psychopathological response to a terrifying experience. Initially associated with combat, PTSD is observed in civilians following traumatic experiences, including violence, accident, natural disaster and life-threatening illness. Lifetime prevalence of PTSD in civilians is between 1% and 9% (Helzer et al, 1987; Breslau et al, 1991; Davidson et al, 1991). Average duration is 3 to 5 years, with many patients experiencing PTSD for more than 10 years (Kessler et al, 1995). Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine and fluoxetine have shown efficacy for up to 3 months in the treatment of PTSD (Connor et al, 1999; Brady et al, 2000; Tucker et al, 2001; Martenyi et al, 2002). Sertraline has shown significant benefit during 24to 28-week maintenance treatment of PTSD (Davidson et al, 2001; Londborg et al, 2001). However, few published studies have examined the efficacy of pharmacotherapies in preventing PTSD relapse, although considerable evidence supports pharmacotherapeutic maintenance treatment for major depression and anxiety, and panic disorders (Montgomery et al, 1988; Frank et al, 1990; Entsuah et al, 1996; Reimherr et al, 1998; Michelson et al, 1999). This study, conducted in Belgium, Bosnia, Croatia, Yugoslavia, Israel and South Africa, was designed to assess the efficacy of fluoxetine in preventing PTSD relapse for up to 6 months.