Pharmacological Management of Post-Traumatic Stress Disorder; A Qualitative Analysis of ClinicalTrials.gov.

Background: Post-traumatic stress disorder (PTSD) is a complex psychiatric condition requiring sustained pharmacological management. Although several medications are used in the clinical practice, post-marketing data on their real-world effectiveness and safety remain limited. Objective: To explore the pharmacological management patterns of PTSD through a qualitative analysis of Phase 4 interventional trials registered on ClinicalTrials.gov. Methods: A qualitative descriptive analysis was conducted using data from completed phase 4 interventional trials addressing pharmacological treatments for PTSD. Studies were identified through a structured search of ClinicalTrials.gov up to 27 June 2025. Eligible trials included pharmacological interventions with posted results. Data were extracted on drug types, therapeutic classes, outcome measures, and sample characteristics, and thematically analysed to identify prevailing research trends. Results: A total of 41 clinical trials were included. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly studied drug class, with multiple trials demonstrating consistent reductions in PTSD symptoms on standardized scales such as the Clinician-Administered PTSD Scale (CAPS). Additional trends included evaluation of hypnotics for sleep disturbance, alpha-1 blockers for nightmares, neuroendocrine agents (eg, mifepristone) for stress hormone regulation, and N-methyl-D-aspartate (NMDA) receptor modulators (eg, d-cycloserine) for memory reconsolidation. Primary outcomes also assessed neuroimaging markers, cortisol levels, and sleep-related metrics. Most studies enrolled small to moderate-sized samples, and variability in design and endpoints highlighted a lack of standardization across trials. Conclusion: This is the first qualitative synthesis of phase 4 PTSD pharmacotherapy trials registered on ClinicalTrials.gov, highlighting real-world safety and long-term tolerability gaps that are not analysed in earlier phase studies. The study concluded that the reliance on SSRIs and the growing exploration of novel pharmacological targets in PTSD. The observed heterogeneity reflects the complexity of the disorder and the fragmented nature of current evidence. Findings emphasize the need for future phase 4 trials with larger sample sizes, standardized outcome measures, and newer pharmacological designs to strengthen the applicability of results to clinical practice.