Abstract / Summary
Objective: To evaluate the efficacy, safety, and tolerability of pharmacological interventions for anxiety outcomes in adults with post-traumatic stress disorder (PTSD), including confirmed comorbid anxiety disorders and clinically significant anxiety symptoms.
Material and methods: PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Cochrane CENTRAL were searched for randomized controlled trials and prospective cohort studies published from 2000 to 2025. Risk of bias was assessed with Cochrane tools, and certainty of evidence with GRADE.
Results: Twenty-two studies involving 2,708 participants were included. Selective serotonin reuptake inhibitors (SSRIs) reduced anxiety symptoms (standardized mean difference [SMD] -0.46; 95% confidence interval [CI] -0.62 to -0.30; moderate certainty) and PTSD symptoms (SMD -0.43; 95% CI -0.58 to -0.28; moderate certainty). However, applicability to formally diagnosed comorbid anxiety disorders was limited by inconsistent diagnostic reporting. Serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced anxiety symptoms (SMD -0.38; 95% CI -0.55 to -0.21; low certainty), whereas evidence for PTSD outcomes was less certain. Atypical antipsychotics showed possible benefit but increased discontinuation due to adverse events (RR 2.14; 95% CI 1.43 to 3.21).
Conclusions: SSRIs provide moderate-certainty evidence for reducing anxiety outcomes in PTSD populations. Evidence for confirmed comorbid anxiety disorders remains limited. SNRIs and atypical antipsychotics have lower-certainty evidence, and atypical antipsychotics are associated with greater adverse-event discontinuation.