Treatment resistance in post-traumatic stress disorder

Abstract

The issue of treatment resistance in PTSD has had little consideration in the literature. This may be due to the dominance of particularly psychotherapeutic approaches that has encourage an overly optimistic view of the treatment outcomes. It has become particularly apparent in veterans’ populations that the majority of patients are left with the disorder after treatment, highlighting treatment resistance as an issue. Despite the extensive literature about the adverse effect of duration of illness on prognosis for disorders such as major depressive disorder which is frequently comorbid with PTSD this has attracted little consideration in PTSD despite its frequent chronicity (Dunlop et al. Behav Sci. 2014;4:511-27). PTSD, like other psychiatric disorders, has a continually evolving dysregulation that has a substantial probability of impacting on treatment outcome. This is underpinned by mechanisms such as sensitisation, kindling and allostatic load that also underpin the increasing somatic comorbidities in PTSD that also need consideration in treatment strategies. It is argued that a staging model of PTSD will lead to more systematic research into the treatment of PTSD and assist in strategies to develop treatment resistance such as a personalised medicine approach.