Treatment phase

As was described in our previous study (10), participants with PTSD received paroxetine (Seroxat) treatment for 12 weeks. The dosage at the beginning of treatment was 10 mg/day, which was increased to 20 mg/day after 4 days. The paroxetine dosage was adjusted based on the judgment of the investigating psychiatrist every 4 weeks by 10 mg/day up to 40 mg/day. The CAPS, Clinical Global Impression (CGI), Hamilton Rating Scale for Depression (HAMD-24), Hamilton Rating Scale for Anxiety (HAMA-14), and Asberg's antidepressant side-effect rating scales (SERS) were assessed every 4 weeks to evaluate the patient's condition and adverse drug reactions. Medication was dispensed during every visit to enhance compliance and reduce chance of misuse. The study psychiatrist and staff inquired about missed doses and conducted a pill count to confirm the participant's report. No participants in the study ever missed more than 2 consecutive daily doses and no subject regularly (>3 times) missed a dose over the course of the 12-week study. The 24/7 emergency telephone number of a psychiatrist was given to all subjects in case of any emergency during treatment. No other drugs were permitted during treatment, unless required for the patients' safety.

The 3-month pharmacotherapy was free of charge for all the participants, and after that, the participants chose to buy and continue taking paroxetine at their own expense. At follow-up, only two participants reported to have continued paroxetine for another 2 months. Other participants did not take any antipsychotic medication after the 3-month treatment for various reasons, primarily because of (1) living in remote mountain areas where antipsychotic medications were locally unavailable, (2) poor socioeconomic conditions that limited travel and funds for medical care, (3) feeling well after the 3-month pharmacotherapy and a lack of understanding or recognition of the severity of mental illness. No participants reported any other life events according to the Life Events Checklist during the follow-up period of 2 years. In addition, three patients reported use of complementary medical treatments with Chinese traditional medicine during the 2 years. Because the effects of the ingredients on brain structure and function were unknown and the three patients stopped taking the medicine for more than 6 months, we did not exclude them from the study.

This study was approved by the Medical Ethics Committee of West China Hospital, Sichuan University, and all subjects gave written informed consent.