How Do Treatment Choices for PTSD Differ Across European Regions?

What you need to know

• While most European psychiatrists correctly identify PTSD, their treatment approaches vary significantly by region
• About 80% of psychiatrists prescribe antidepressants for PTSD, with sertraline being the most common choice
• Benzodiazepines and antipsychotics are prescribed more frequently in Central/Eastern Europe compared to Northern and Western regions
• Only about half of psychiatrists follow established treatment guidelines for PTSD

Regional Differences in Treatment Approaches

Psychiatrists’ treatment choices for Post-Traumatic Stress Disorder (PTSD) show notable differences across European regions. The study identified four main regions: Central/Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE).

Medication Preferences

The use of antidepressants is common across all regions, but with important variations:

• Southern and Central/Eastern Europe show the highest rates (around 90%)
• Northern and Western Europe have lower rates (58-77%)
• Sertraline is the preferred antidepressant across all regions
• Benzodiazepines are prescribed much more frequently in Central/Eastern Europe (33%) compared to Northern (11%) and Southern Europe (9%)

Psychotherapy Approaches

Despite regional differences in medication use, some therapy approaches are consistently recommended:

• About 52% recommend trauma-focused cognitive behavioral therapy (CBT)
• 35% recommend psychoeducation
• The availability of specific therapies varies significantly by region
• Eye Movement Desensitization and Reprocessing (EMDR) is more commonly available in Northern and Western Europe

Treatment Patterns and Professional Profiles

The research identified four distinct groups of clinicians based on their treatment approaches:

1. “Conventional Antidepressant” Group (60.1%):

• Less likely to prescribe antidepressants overall
• Most likely to recommend sertraline when prescribing

2. “Trazodone and Exposure Therapy” Group (8.4%):

• Focuses on trazodone as medication
• Emphasizes prolonged exposure therapy

3. “Mirtazapine and EMDR” Group (10.6%):

• Prefers mirtazapine as medication
• Commonly recommends EMDR therapy

4. “Comprehensive Medication and CPT” Group (21%):

• Uses various medications including benzodiazepines
• Emphasizes cognitive processing therapy

Guidelines and Clinical Practice

A concerning finding is that about half of psychiatrists across all regions report not following any specific treatment guidelines. Among those who do use guidelines:

• Northern and Western European psychiatrists prefer national guidelines
• Southern and Central/Eastern European practitioners use a mix of national, NICE, and WHO guidelines

Conclusions

• Treatment approaches for PTSD vary significantly across European regions, reflecting different healthcare systems and traditions
• While antidepressants are commonly prescribed everywhere, the use of additional medications like benzodiazepines shows strong regional patterns
• Access to different types of psychotherapy varies considerably between regions
• There is a need for more standardization in treatment approaches and better implementation of clinical guidelines
• More dialogue and education are needed to harmonize PTSD treatment practices across Europe