意思是說,好一點之後,rexulti 就可以撤,留下 Zoloft 即可,
Here’s what current evidence tells us about Zoloft (sertraline) and Rexulti (brexpiprazole) for treating PTSD:
Zoloft (Sertraline)
1. Official Status & Guidelines
- Zoloft is FDA‑approved for PTSD and considered a first-line pharmacological treatment, alongside Paroxetine .
- Clinical practice guidelines (e.g., APA, VA/DoD) recognize SSRIs—especially Sertraline and Paroxetine—as having the most robust evidence from randomized controlled trials .
2. Effectiveness
- A meta-analysis of 21 PTSD trials (2021) supports the efficacy of SSRIs like sertraline, with an estimated treatment response rate of 50–60% .
- According to Wikipedia, sertraline produces modest improvements, particularly in cases of sexual or physical assault in women, though results in men may be less robust .
- In pooled trials across multiple indications (not just PTSD), sertraline showed significant improvement over placebo, supporting its broader efficacy .
3. Summary
- Conclusion: Zoloft is evidence-supported and guideline-recommended for PTSD, typically yielding modest to moderate symptom reduction.
- Limitations: It helps many, but a substantial portion of patients (~40–60%) may not respond fully .
- Best Use: Often paired with trauma-focused psychotherapy (TF‑CBT), which remains the gold standard treatment .
Rexulti (Brexpiprazole)
— Particularly in Combination with Sertraline
1. Recent Clinical Trial Data
- Combination therapy trial (2025): A Phase 3 randomized, double-blind trial showed that brexpiprazole + sertraline led to a statistically significant reduction in PTSD symptoms (CAPS-5 score improvement of –19.2 vs –13.6; p < .001) .
- The combination was generally well-tolerated, with side effects consistent with known brexpiprazole profiles .
2. Regulatory Status & Controversy
- FDA Panel Decision (2025): An FDA advisory committee voted 10‑1 against recommending approval of the brexpiprazole + sertraline combination for PTSD. Reasons included inconsistent results and modest clinical benefit .
- Notably, although one late-stage trial was positive, another failed to show significant difference from sertraline alone .
3. Summary
- Conclusion: The brexpiprazole + sertraline combination shows preliminary promise but lacks sufficient consistent evidence for approval. More studies and replication are needed.
- Note: As of now, Rexulti remains off-label for PTSD, pending clearer regulatory outcomes.
Quick Comparison
Medication / Strategy |
Evidence Quality |
FDA Status |
Notes |
Zoloft (sertraline) |
Strong RCT support, meta-analyses |
FDA-approved |
Modest efficacy; standard first-line |
Rexulti + Sertraline (combo) |
Promising Phase 3 results |
Not yet approved |
Mixed trial outcomes; pending FDA review |
Rexulti monotherapy |
Little to no evidence |
Off-label |
Not studied as a stand-alone PTSD agent |
Bottom Line
- Zoloft remains a validated, guideline-backed treatment for PTSD, effective for many though not all.
- Rexulti plus Zoloft offers a hopeful possibility—but currently lacks enough consistent, compelling results to earn regulatory approval.
- For best outcomes, psychotherapy (particularly trauma-focused CBT) paired with medications like Zoloft continues to be the core recommendation.
Further reading