Efficacy of pharmacotherapy for psychiatric sequelae of torture

Introduction: The large numbers of torture survivors suffering from post-traumatic stress disorder and other psychological trauma in the United States suggests pharmacists should be aware of, and attentive to possible drug therapies for this population. Method: To this end, we systematically review the literature on pharmacotherapy for survivors of torture. Published literature that assessed use of pharmacotherapy in torture victims were searched from MEDLINE, Cochrane Library, PsychInfo and CINAHL. Search terms “torture,” “pharmacotherapy,” “depression OR PTSD,” “refugee OR asylum seekers” and “treatment or rehabilitation” were utilized. Results: Review of controlled and uncontrolled studies reveal that antidepressants are the most widely studied medications, particularly sertraline, a selective-serotonin reuptake inhibitor, in the torture survivor population expanding to refugees and asylum seekers. Anti-adrenergic medications were used as adjunctive treatment in some uncontrolled studies. In randomized controlled trials, pharmacotherapy did not differentiate from placebo in reducing symptoms. Uncontrolled trials had yielded variable outcomes from pharmacotherapy. Discussion: There is lack of strong evidence in supporting the use of pharmacotherapy for the treatment of post-traumatic stress disorder and major depressive disorder. Heterogeneity in the study design, patient ethnicity and the social and political status at the time of the study may have contributed in the variable clinical responses to pharmacotherapy.