Pharmacotherapy for post traumatic stress disorder (PTSD)

doi:10.1002/14651858.CD002795.pub2

Intervention Review

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Pharmacotherapy for post traumatic stress disorder (PTSD)

Dan J Stein^1,*,
Jonathan C Ipser²,
Soraya Seedat²

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 13 OCT 2005

DOI: 10.1002/14651858.CD002795.pub2

Database Title

The Cochrane Library

Additional Information

How to Cite

Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD002795. DOI: 10.1002/14651858.CD002795.pub2.

Author Information

¹
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa
²
University of Stellenbosch, MRC Research Unit for Anxiety and Stress Disorders, Tygerberg, Western Cape, South Africa

^*Dan J Stein, Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road, Rondebosch, Cape Town, 7700, South Africa. dan.stein@uct.ac.za. djs2@sun.ac.za.

Publication History

Publication Status: Edited (no change to conclusions)
Published Online: 21 JAN 2009

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References

References to studies included in this review

References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
References to ongoing studies
Additional references

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Baker DG, Diamond BI, Gillette G, Hamner M, Katzelnick D, Keller T, et al. A double-blind randomized placebo-controlled multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology 1995;122(4):386-9.
Connor KM, Hidalgo RB, Crockett B, Malik M, Katz RJ, Davidson JR. Predictors of treatment response in patients with posttraumatic stress disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2001;25(2):337-45.

Brady 2000 {published data only}

Brady K, Pearlstein T, Asnis GM, Baker D, Rothbaum B, Sikes CR, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder. Archives of General Psychiatry 2000;283(14):1837-44.
Davidson J, Pearlstein T, Londborg P, Brady KT, Rothbaum B, Bell J, et al. Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: Results of a 28-week double-blind, placebo-controlled study. American Journal of Psychiatry 2001;158(12):1974-81.
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Brady KT, Sonne S, Anton RF, Randall CL, Back SE, Simpson K. Sertraline in the treatment of co-occuring alcohol dependence and PTSD. Draft manuscript.
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Braun P, Greenberg D, Dasberg H, Lerer B. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. Journal of Clinical Psychiatry 1990;51(6):236-8.

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Butterfield MI, Becker ME, Connor KM, Sutherland S, Churchill LE, Davidson JR. Olanzapine in the treatment of post-traumatic stress disorder: A pilot study. International Clinical Psychopharmacology 2001;16(4):197-203.

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Davidson 1990 {published data only}

Davidson JR, Kudler H, Smith R, Mahorney SL, Lipper S, Hammett E, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Archives of General Psychiatry 1990;47(3):259-66.
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Davidson 2001 {published data only}

Davidson J, Londborg P, Pearlstein T, Rothbaum B, Brady K, Farfel G. Double-blind, randomized, 28-week continuation study of sertraline and placebo in posttraumatic stress disorder. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):292.
Davidson J, Pearlstein T, Londborg P, Brady KT, Rothbaum B, Bell J, et al. Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study. American Journal of Psychiatry 2001;158(12):1974-81.
Davidson JR, Landerman LR, Farfel GM, Clary CM. Characterizing the effects of sertraline in post-traumatic stress disorder. Psychological Medicine 2002;32(4):661-70.
Davidson JR, Rothbaum BO, van der Kolk BA, Sikes CR, Farfel GM. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Archives of General Psychiatry 2001;58(5):485-92.
Rapaport MH, Endicott J, Clary CM. Posttraumatic stress disorder and quality of life: Results across 64 weeks of sertraline treatment. Journal of Clinical Psychiatry 2002;63(1):59-65.

Davidson 2003 {published data only}

Davidson JR, Weisler RH, Butterfield MI, Casat CD, Connor KM, Barnett S, et al. Mirtzapine vs. placebo in posttraumatic stress disorder: A pilot trial. Biological Psychiatry 2003;53(2):188-91.

Davis 2001 {published data only}

Davis LL, Ambrose S, English B, Dafore ME, Farley J, Bartolucci Al, et al. A placebo-controlled study of nefazodone for the treatment of chronic posttraumatic stress disorder. 20th Annual Meeting, International Society for Traumatic Stress Studies, December 6 - 9, New Orleans, LA. 2001.
Davis LL, Jewell ME, Ambrose S, Farley J, English B, Bartolucci A, et al. A placebo-controlled study of nefazadone for the treatment of chronic posttraumatic stress disorder. Journal of Clinical Psychopharmacology 2004;24(3):291-7.

Eli Lilly {unpublished data only}

Eli Lilly. Unpublished data. Appendix 14 of 2nd consultation draft for the NICE (2005) PTSD guidelines.

Hertzberg 1999 {published data only}

Hertzberg MA, Butterfield MI, Feldman ME, Beckham JC, Sutherland SM, Connor KM, et al. A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biological Psychiatry 1999;45(9):1226-9.

Hertzberg 2000 {published data only}

Hertzberg MA, Feldman ME, Beckham JC, Kudler HS, Davidson JR. Lack of efficacy for fluoxetine in PTSD: A placebo controlled trial in combat veterans. Annals of Clinical Psychiatry 2000;12(2):101-5.
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Kaplan Z, Amir M, Swartz M, Levine J. Inositol treatment of post-traumatic stress disorder. Anxiety 1996;2(1):51-2.
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Katz 1994 {published data only}

Connor KM, Hidalgo RB, Crockett B, Malik M, Katz RJ, Davidson JR. Predictors of treatment response in patients with posttraumatic stress disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2001;25(2):337-45.
Katz RJ, Lott MH, Arbus P, Crocq L, Herlobsen P, Lingjaerde O, et al. Pharmacotherapy of post-traumatic stress disorder with a novel psychotropic. Anxiety 1994;1(4):169-74.
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Kosten TR, Frank JB, Dan E, McDougle CJ, Giller EL Jr. Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. Journal of Nervous and Mental Disease 1991;179(6):366-70.

Marshall 2001 {published data only}

Marshall RD, Beebe KL, Oldham M, Zaninelli R. Efficacy and safety of paroxetine treatment for chronic PTSD: A fixed-dose, placebo-controlled study. American Journal of Psychiatry 2001;158(12):1982-8.

Marshall 2004 {unpublished data only}

Marshall R, Blanco C, Lewis-Fernandez R, Simpson B, Lin SH, Garcia W, et al. Randomized controlled trial of paroxetine in adults with chronic PTSD. 18th Annual Meeting, International Society for Traumatic Stress Studies, November 7 - 10, Baltimore, MD. 2002.
Marshall RD, Lewis-Fernandez R, Blanco C, Simpson HB, Lin S, Garcia W, et al. A controlled trial of paroxetine for chronic PTSD, dissociation and interpersonal problems in mostly minority adults. draft manuscript.

Martenyi 2002 {published data only}

Martenyi F, Brown EB, Zhang H, Koke SC, Prakash A. Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder.. British Journal of Psychiatry 2002;181:315-20.
Martenyi F, Brown EB, Zhang H, Prakash A, Koke SC. Fluoxetine versus placebo in posttraumatic stress disorder. Journal of Clinical Psychiatry 2002;63(3):199-206.

McRae 2004 {published data only}

McRae AL, Brady KT, Mellman TA, Sonn SC, Killeen TK, Timmerman MA, et al. Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depression and Anxiety 2004;19(3):190-6.
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Pfizer588 {unpublished data only}

Pfizer. Unpublished data. Appendix 14 of 2nd consultation draft for the NICE (2005) PTSD guidelines.

Pfizer589 {unpublished data only}

Pfizer. Unpublished data. Appendix 14 of 2nd consultation draft for the NICE (2005) PTSD guidelines.

Reich 2004 {published data only}

Reich DB, Winternitz S, Hennen J, Watts T, Stanculescu C. A preliminary study of risperidone in the treatment of postraumatic stress disorder related to childhood abuse in women. Journal of Clinical Psychiatry 2004;65(12):1601-5.

Reist 1989 {published data only}

Reist C, Kauffmann CD, Chicz Demet A, Chen CC, Demet EM. REM latency, dexamethasone suppression test, and thyroid releasing hormone stimulation test in posttraumatic stress disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 1995;19(3):433-43.
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Saygin 2002 {published data only}

Saygin MZ, Sungur MZ, Sabol EU, Cetinkaya P. Nefazodone versus sertraline in treatment of posttraumatic stress disorder. Bulletin of Clinical Psychopharmacology 2002;12(1):1-5.
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Shestatzky 1988 {published data only}

Shestatzky M, Greenberg D, Lerer B. A controlled trial of phenelzine in posttraumatic stress disorder. Psychiatric Research 1988;24(2):149-55.

SKB627 {unpublished data only}

SmithKline Beecham. Unpublished data. Appendix 14 of 2nd consultation draft for the NICE (2005) PTSD guidelines.

Smajkic 2001 {published data only}

Smajkic A, Weine S, Djuric-Bijedic Z, Boskailo E, Lewis J, Pavkovic I. Sertraline, paroxetine, and venlafaxine in refugee posttraumatic stress disorder with depression symptoms. Journal of Traumatic Stress 2001;14(3):445-52.
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Tucker 2001 {published data only}

Tucker P, Zaninelli R, Yehuda R, Ruggiero L, Dillingham K, Pitts CD. Paroxetine in the treatment of chronic posttraumatic stress disorder: Results of a placebo-controlled, flexible-dosage trial. Journal of Clinical Psychiatry 2001;62(11):860-8.

Tucker 2003 {published data only}

Tucker P, Potter-Kimball R, Wyatt DB, Parker DE, Burgin C, Jones DE, et al. Can physiologic assessment and side effects tease out differences in PTSD trials? A double-blind comparison of citalopram, sertraline, and placebo. General Psychopharmacology 2003;37(3):135-49.
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van der Kolk 1994 {published data only}

van der Kolk BA, Dreyfuss D, Michaels M, Shera D, Berkowitz R, Fisler R, et al. Fluoxetine treatment in posttraumatic stress disorder. Journal of Clinical Psychiatry 1994;55(12):517-22.
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van der Kolk 2004 {unpublished data only}

van der Kolk, Spinazzola J, Blaustein M, Hopper J, Hopper E, Korn D, et al. A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. draft manuscript.

Zohar 2002 {published data only}

Amital D, Zohar J, Kotler M, Bleich A, Miodovnik H, Nevo A ET AL. A placebo-controlled study of sertraline in post traumatic stress disorder. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):269.
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References to studies excluded from this review

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References to studies awaiting assessment
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Additional references

Aerni 2004 {published data only}

Aerni A, Traber R, Hock C, Roozendaal B, Schelling G, Papassotiropoulos A, et al. Low-dose cortisol for symptoms of posttraumatic stress disorder. American Journal of Psychiatry 2004;161(8):1488-90.

Bartzokis 2005 {published data only}

Bartzokis G, Lu PH, Turner J, Mintz J, Saunders CS. Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder. Biological Psychiatry 2005;57(5):474-9.

Bremner 1997 {published data only}

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Gelpin E, Bonne O, Peri T, Brandes D, Shalev AY. Treatment of recent trauma survivors with benzodiazepines: A prospective study. Journal of Clinical Psychiatry 1996;57(9):390-4.

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Kellner 2000 {published data only}

Kellner M, Wiedemann K, Yassouridis A, Levengood R, Guo LS, Holsboer F, et al. Behavioral and endocrine response to cholecystokinin tetrapeptide in patients with posttraumatic stress disorder. Biological Psychiatry 2000;47(2):107-11.

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Monnelly EP, Ciraulo DA, Knapp C, Keane T. Low-dose risperidone as adjunctive therapy for irritable aggression in posttraumatic stress disorder. Journal of Clinical Psychopharmacology 2003;23(2):193-6.

Morgan 1995 {published data only}

Morgan CA 3rd, Grillon C, Southwick SM, Nagy LM, Davis M, Krystal JH, et al. Yohimbine facilitated acoustic startle in combat veterans with post-traumatic stress disorder. Psychopharmacology 1995;117(4):466-71.

Nagy 1996 {unpublished data only}

Nagy LM, Southwick SM, Charney DS. Placebo-controlled trial of fluoxetine in PTSD. International Society for Traumatic Stress Studies 12th Annual Meeting, San Francisco, CA, November 11. 1996.

Otto 2003 {published data only}

Otto MW, Hinton D, Korbly NB, Chea A, Ba P, Gershuny BS, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behaviour Research and Therapy 2003;41:1271-6.

Pitman 1990 {published data only}

Pitman RK, van der Kolk BA, Orr SP, Greenberg MS. Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder. Archives of General Psychiatry 1990;47(6):541-4.

Pitman 2002 {published data only}

Pitman RK, Sanders KM, Zusman RM, Healy AR, Cheema F, Lasko NB, et al. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological Psychiatry 2002;51(2):189-92.

Pivac 2004 {published data only}

Pivac N, Kozaric-Kovacic D, Muck-Seler D. Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder. Psychopharmacology 2004;175(4):451-6.

Randall 1995 {published data only}

Randall PK, Bremner JD, Krystal JH, Nagy LM, Heninger GR, Nicolaou AL, et al. Effects of the benzodiazepine antagonist flumazenil in PTSD. Biological Psychiatry 1995;38(5):319-24.

Raskind 2003 {published data only}

Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson CE, et al. Reducation of nightmares and other PTSD symptoms in combat veterans by prazosin: A placebo-controlled study. American Journal of Psychiatry 2003;160(2):371-3.

Reist 1995 {published data only}

Reist C, Kauffmann CD, Chicz Demet A, Chen CC, Demet EM. REM latency, dexamethasone suppression test, and thyroid releasing hormone stimulation test in posttraumatic stress disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 1995;19(3):433-43.

Reist 2001 {published data only}

Reist C, Duffy JG, Fujimoto K, Cahill L. beta-Adrenergic blockade and emotional memory in PTSD. International Journal of Neuropsychopharmacology 2001;4(4):377-83.

Schelling 2004 {published data only}

Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J, Dagge A, et al. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: A randomized study. Biological Psychiatry 2004;55(6):627-33.

Southwick 1997 {published data only}

Southwick SM, Krystal JH, Bremner JD, Morgan CA 3rd, Nicolaou AL, Nagy LM, et al. Noradrenergic and serotonergic function in posttraumatic stress disorder. Archives of General Psychiatry 1997;54(8):749-58.

Stein 2002 {published data only}

Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: A double-blind, placebo-controlled study. American Journal of Psychiatry 2002;159(10):1777-9.

Vaiva 2003 {published data only}

Vaiva G, Ducrocq F, Jezequel K, Averland B, Lestavel P, Brunet A, et al. Immediate Treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biological Psychiatry 2003;54(9):947-9.

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van der Kolk BA, Greenberg MS, Orr SP, Pitman RK. Endogenous opioids, stress induced analgesia, and posttraumatic stress disorder. Psychopharmacology Bulletin 1989;25(3):417-21.
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References to studies awaiting assessment

References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
References to ongoing studies
Additional references

Fluoxetine, Davidson {published data only (unpublished sought but not used)}

Fluoxetine, Lilly {published data only (unpublished sought but not used)}

Nefazodone 1, BMS {published data only (unpublished sought but not used)}

Nefazodone 2, BMS {published data only (unpublished sought but not used)}

Olanzapine, Davidson {published data only}

Paroxetine 2 - SB {published data only (unpublished sought but not used)}

Paroxetine 3 - SB {published data only (unpublished sought but not used)}

Sertraline 2, Pfizer {published data only (unpublished sought but not used)}

Sertraline 3, Pfizer {unpublished data only}

Sertraline 4, Pfizer {published data only}

SKB650 {unpublished data only}

SmithKline Beecham. Unpublished data. Appendix 14 of 2nd consultation draft for the NICE (2005) PTSD guidelines.

References to ongoing studies

References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
References to ongoing studies
Additional references

Davis 2003 {published data only (unpublished sought but not used)}

Davis L, Petty F. Gabaergic modulation in PTSD and treatment with anticonvulsants. 19th Annual Meeting, International Society for Traumatic Stress Studies, October 29 - November 1, Chicago, IL. 2003.

DVA (unknown) {unpublished data only}

Department of Veterans Affairs (sponsors). CSP #504 - Risperidone Treatment for Military Service Related Chronic Post-Traumatic Stress Disorder. http://clinicaltrials.gov/show/NCT00099983.

Mechoulam (THC) {unpublished data only}

Raphael Mechoulam. delta-9 tetrahydrocannabino (THC) for combat-related post traumatic stress disorder. http://www.medscape.com/. Reuters Ltd.

Mithoefer 2005 {unpublished data only}

Mithoefer, M. A Test of MDMA-assisted Psychotherapy in People with Posttraumatic Stress Disorder. Current controlled trials (http://clinicaltrials.gov/show/NCT00090064).

NIAAA 2005 {unpublished data only}

National Institute on Alcohol Abuse and Alcoholism (sponsors). Treatment for Alcoholism and Post-Traumatic Stress Disorder (naltrexone). Current controlled trials (http://clinicaltrials.gov/show/NCT00006489).

Tucker 2004 {published data only (unpublished sought but not used)}

Tucker P, Davis L, Cohen J. Pharmacotherapy of PTSD: Trauma and neurotransmitters across the lifespan. 20th Annual Meeting, International Society for Traumatic Stress Studies, November 14 - November 18, New Orleans, LA. 2004.

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References

References to studies included in this review

Baker 1995 a {published data only}

Brady 2000 {published data only}

Brady 2004 {unpublished data only}

Braun 1990 {published data only}

Butterfield 2001 {published data only}

Chung 2004 {published data only}

Conner 1999 {published data only}

Davidson {unpublished data only}

Davidson 1990 {published data only}

Davidson 2001 {published data only}

Davidson 2003 {published data only}

Davis 2001 {published data only}

Eli Lilly {unpublished data only}

Hertzberg 1999 {published data only}

Hertzberg 2000 {published data only}

Kaplan 1996 {published data only}

Katz 1994 {published data only}

Kosten 1991 {published data only}

Marshall 2001 {published data only}

Marshall 2004 {unpublished data only}

Martenyi 2002 {published data only}

McRae 2004 {published data only}

Pfizer588 {unpublished data only}

Pfizer589 {unpublished data only}

Reich 2004 {published data only}

Reist 1989 {published data only}

Saygin 2002 {published data only}

Shestatzky 1988 {published data only}

SKB627 {unpublished data only}

Smajkic 2001 {published data only}

Tucker 2001 {published data only}

Tucker 2003 {published data only}

van der Kolk 1994 {published data only}

van der Kolk 2004 {unpublished data only}

Zohar 2002 {published data only}

References to studies excluded from this review

Aerni 2004 {published data only}

Bartzokis 2005 {published data only}

Bremner 1997 {published data only}

Coupland 1997 {published data only}

Eftekhari 2004 {unpublished data only}

Frank 1988 {published data only}

Frommberger 1998 {published data only}

Gelpin 1996 {published data only}

Hamner 1997 {published data only}

Hamner 1999 {published data only}

Hamner 2003 {published data only}

Heresco-Levy 2002 {published data only}

Jacobs-Rebhun 2000 {published data only}

Kanter 2001 {published data only}

Kellner 2000 {published data only}

Kline 1994 {published data only}

Monnelly 2003 {published data only}

Morgan 1995 {published data only}

Nagy 1996 {unpublished data only}

Otto 2003 {published data only}

Pitman 1990 {published data only}

Pitman 2002 {published data only}

Pivac 2004 {published data only}

Randall 1995 {published data only}

Raskind 2003 {published data only}

Reist 1995 {published data only}

Reist 2001 {published data only}

Schelling 2004 {published data only}

Southwick 1997 {published data only}

Stein 2002 {published data only}

Vaiva 2003 {published data only}

van der Kolk 1989 {published data only}