Tackling the global problem of traumatic stress in low-income countries: a pilot clinical trial comparing reconsolidation therapy to paroxetine in Nepal

BMC Psychiatry. 2021 Sep 3;21(1):434. doi: 10.1186/s12888-021-03441-6.

Abstract

Background: Traumatic stress is a global mental health problem requiring novel, easily implemented treatment solutions. We compared the effectiveness and efficiency of Reconsolidation Therapy (RT) to the well-established antidepressant paroxetine, in reducing symptoms of traumatic stress among patients from Nepal, a low-income country.

Methods: Forty-six adults with posttraumatic stress disorder (PTSD) were randomized to one of two groups. The reconsolidation blocker propranolol was administered 90 min before briefly recalling a traumatic memory with a therapist, weekly for six consecutive weeks. This was compared to daily paroxetine for 26 weeks. Self-reported PTSD symptoms were assessed blindly at the 7th, 13th, and 26th weeks.

Results: An intent-to-treat analysis revealed a robust pre- to post-treatment main effect (β1 = - 4.83, 95% CI = [- 5.66, - 4.01], p < .001), whereby both groups improved, with Cohen's effect sizes of d = 2.34 (95% CI = [1.57, 3.12]) for paroxetine, and of 2.82 (95% CI = [1.98, 3.66]) for RT after 7 weeks, suggesting treatment effectiveness for both groups in a real-world setting. Three and six-month follow-up yielded further significant improvement in both groups, which did not differ from each other.

Conclusion: RT also displayed promising efficiency, considering that it had been discontinued weeks earlier while the paroxetine treatment was continued, as recommended. RT could be taught in low-income countries as part of the local therapeutic resources to treat the core symptoms of PTSD, provided that such results are replicated on a broader scale.

Trial registration: ISRCTN34308454 (11/10/2017).

Keywords: Effectiveness; Efficiency; Low– and middle–income countries; Paroxetine; Propranolol; Randomized controlled trial; Reconslidation therapy; Traumatic stress; Treatment.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Humans
  • Nepal
  • Paroxetine* / therapeutic use
  • Poverty
  • Stress Disorders, Post-Traumatic* / drug therapy
  • Treatment Outcome

Substances

  • Paroxetine