Evidence unclear on treating U.S. veterans' stress

WASHINGTON (Reuters) - Many U.S. combat veterans from Iraq and Afghanistan are clearly suffering from post-traumatic stress disorder, but it is not at all clear which treatments work to help them, an Institute of Medicine panel said on Thursday.

The only therapies that have been shown to work are so-called exposure therapies, in which people are guided in a gradual, step-by-step confrontation with a fear or stressor, the expert committee said.

"At this time, we can make no judgment about the effectiveness of most psychotherapies or about any medications in helping patients with PTSD," said Dr. Alfred Berg of the University of Washington in Seattle.

"These therapies may or may not be effective -- we just don't know in the absence of good data," Berg, the panel chairman, said in a statement. "Our findings underscore the urgent need for high-quality studies that can assist clinicians in providing the best possible care to veterans and others who suffer from this serious disorder."

PTSD is the most commonly diagnosed service-related mental disorder among military personnel returning from Iraq and Afghanistan, said the institute, which advises the federal government on health and medical matters.

It said surveys have shown that 12.6 percent of personnel who fought in Iraq and 6.2 percent who were in Afghanistan have experienced PTSD.

The committee appointed by the institute reviewed 53 studies of drugs and 37 studies of psychotherapy approaches used to treat PTSD.

Most of the studies were not conducted properly enough to provide a solid answer, they said.

"The majority of drug studies have been funded by the pharmaceutical manufacturers, and the majority of psychotherapy studies have been conducted by the individuals who developed the techniques or their close collaborators," the panel said in a statement.

Drugs studied included anticonvulsants, antipsychotics, tranquilizers and antidepressants. Several studies had problems with participants who discontinued treatment, it said.

The government and research community need to take urgent steps "to ensure that the right studies are undertaken to yield clearer, more reliable data that would help clinicians treat PTSD sufferers," the panel concluded.

Dr. Antonette Zeiss, VA's deputy chief of mental health services, said the agency has been using the proven approach. It also uses drugs to treat veterans.

"It is important to note... the IOM conclusion states only more research is needed, not that medications have been found to be ineffective," it said in a statement.