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This pragmatic clinical trial compared the effectiveness of selective serotonin reuptake inhibitors (SSRIs) to brief trauma-focused psychotherapy (written exposure therapy, WET) in treating PTSD among primary care patients. Both modalities showed similar PTSD symptom reduction in adherent patients over 4 months. For patients not responding to initial SSRI treatment, switching to a serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine was significantly more effective than augmenting with WET. The findings support feasibility and benefit of both treatments in primary care and suggest SNRI switch as a preferred second-step strategy after SSRI failure.
