{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T17:05:40Z","timestamp":1764867940294,"version":"3.46.0"},"reference-count":43,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychother Psychosom"],"abstract":"<jats:p>Introduction: Psychotropic medications are frequently prescribed alongside trauma-focused psychotherapy for post-traumatic stress disorder (PTSD), yet their impact on treatment response remains uncertain. This study emulated target trials to examine the association between psychotropic co-medication at treatment onset and psychotherapy outcomes in a real-world PTSD cohort. Methods: A prospective cohort of 6,125 adults with chronic or delayed-onset PTSD received a standardized 2\u20138 day trauma-focused psychotherapy program, including daily prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy, at a Dutch psychotrauma center (2021\u20132024). Target trial emulation with double machine learning with inverse probability of treatment weighting estimated the effects of specific psychotropic co-medications versus non-use on changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (range, 0\u201380) from pre-to post-treatment. Results: Mean CAPS-5 scores improved by 25.7 points (Cohen\u2019s d = \u22122.30). Psychotropic co-medication (n = 1,382) was associated with reduced symptom improvement compared with non-use (model-estimated difference = \u22122.52 points; relative reduction = \u22129.4%, 95% CI = \u221210.0 to \u22128.9; d = \u22121.11, E = 10.0). This effect persisted at 6-month follow-up (d = \u22120.42). Antidepressants overall (d = \u22120.28; follow-up d = \u22120.56), amitriptyline (d = \u22120.51), and mirtazapine (d = \u22120.29) were consistently associated with poorer outcomes across sensitivity analyses. Similar patterns were observed for anticonvulsants, mood-stabilizing anticonvulsants, antipsychotics, fluoxetine, zolpidem, and zopiclone. Sensitivity analyses and E-values indicated robustness to unmeasured confounding. Conclusion: Several psychotropic co-medications were associated with reduced outcomes of evidence-based trauma-focused psychotherapy for PTSD. By identifying this as a potentially modifiable factor, psychotherapy outcomes may be optimized. Trials are warranted to evaluate whether tapering or substituting these agents improves outcomes.<\/jats:p>","DOI":"10.1159\/000549259","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T17:01:45Z","timestamp":1762794105000},"page":"1-19","source":"Crossref","is-referenced-by-count":0,"title":["Concomitant Psychotropic Medication Is Associated with Reduced Outcomes of Trauma-Focused Psychotherapy for Post-Traumatic Stress Disorder"],"prefix":"10.1159","author":[{"given":"Serge A.","family":"Steenen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roos","family":"van Westrhenen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilo C.","family":"Steenen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Thomas","family":"Klausch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ad","family":"De Jongh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1353383"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1729633"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X21666230428091433"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1802920"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-023-02495-2"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1853379"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2025.0442"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1159\/000527850"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-022-00929-x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2017.03.007"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2024.05.032"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2022.102607"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000942"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291723003446"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.21383"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwz100"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.7741"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.3758"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(24)00040-3"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(24)00104-4"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-071108"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1111\/ectj.12097"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2018.1546085"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.5765\/jkacap.250017"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2018.1492836"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(00)00314-0"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1214\/12-aos1058"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1159\/000490574"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmip.2025.100161"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2018.304337"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.3389\/FPSYG.2018.01395"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/s0005-7967(01)00024-9"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.2174\/1874143600802010054"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1038\/s41386-022-01523-x"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.09020149"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.01.009"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1037\/bul0000152"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2012.00117"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1037\/pas0001130"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-022-02173-9"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1783955"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000899"}],"container-title":["Psychotherapy and Psychosomatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000549259","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T17:01:27Z","timestamp":1764867687000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000549259"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":43,"URL":"https:\/\/doi.org\/10.1159\/000549259","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.30468761","asserted-by":"subject"}]},"ISSN":["0033-3190","1423-0348"],"issn-type":[{"type":"print","value":"0033-3190"},{"type":"electronic","value":"1423-0348"}],"subject":[],"published":{"date-parts":[[2025,11,10]]}}}