PTSD: The Medications (original) (raw)
Related papers
Psychiatric Annals, 2003
Since each us has previously published reviews of medication treat ment for adults and children with posttraumatic stress disorder (PTSD),[1-3 ] we approach the subject somewhat differently in this arti cle. We ask and answer 11 questions that we believe encompass major con cerns of prescribing psychiatrists about medication treatment for adults or children with PTSD. We hope that this presentation provides a syn thesis of research literature in a form that directly addresses common clinical decisions. When Do You Use Medication for PTSD? There is no simple rule that determines the choice of medication use in PTSD. Rather, medication should be considered an option among several potential therapeu tic interventions including cognitive behavioral thera py, psycho-education, supportive therapy, and family therapy. Decisions to use medications are appropriately tailored to individual patient needs and influenced by patient concerns and preferences.
Psychopharmacological treatment in PTSD: a critical review
Journal of Psychiatric Research, 2002
Introduction: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder that is heterogeneous in its nature, and often presents with other psychiatric comorbidities. As a result, empirical research on effective pharmacotherapy for PTSD has produced complex findings. This article reviews the existing research literature on pharmacological treatments for PTSD, identifies the most effective treatments, and where possible examines their mechanism of action with respect to the neurobiology of PTSD. Methods: We examined reports of clinical trials of psychotropic agents carried out with PTSD patients and published in peerreviewed journals, as well as reports from presentations at scientific meetings between 1966 and 2001. Results: Numerous medications are effective in treating PTSD. These include tricyclic antidepressants, monoamine oxidase inhibitors, and serotonin reuptake inhibitors. Considering reported overall efficacy and side effects profiles, selective serotonin reuptake inhibitors emerge as the preferred first line treatment for PTSD. Mood stabilizers, atypical neuroleptics, adrenergic agents, and newer antidepressants also show promise, but require further controlled trials to clarify their place in the pharmacopoeia for PTSD. Discussion: There is clear evidence for effective pharmacotherapy of PTSD. Future improvements in the treatment of this disorder await further clinical trials and neurobiological research. Published by Elsevier Science Ltd.
Pharmacotherapy of PTSD: Current Status and Controversies
Psychiatric Annals, 2009
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder in populations exposed to trauma, and it is among the most functionally-impairing, similar in scope to that observed in mood disorders. Recent years have seen many treatment studies assessing efficacy of diverse pharmacotherapies for PTSD. This article reviews the established, evidence-based pharmacotherapeutic treatments for PTSD and highlights current recommendations and controversial areas. The article primarily focuses on published randomized clinical trials that tested overall symptom reduction in PTSD compared to placebo. We also briefly review efforts to target particular symptoms commonly associated with PTSD (eg, sleep disturbance; psychotic symptoms) and at preventing PTSD among populations recently exposed to trauma. Where appropriate, recommendations are made for use of particular agents as first-line pharmacotherapies.
Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2009
The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. The aim of this study was to address this limitation by systematically reviewing the options left for the treatment of PTSD when patients do not respond satisfactorily to or tolerate SSRIs. A systematic review covering all original articles, letters and brief reports published in any language until October 2008 was conducted through searches in the ISI/Web of Science, PubMed and PILOTS databases. The search terms included the pharmacological class of each agent or its generic name plus "PTSD" or "stress disorder" in the title, in the abstract or as a keyword. Sixty-three articles were selected, covering the following categories: antipsychotics, anticonvulsants, adrenergic-inhibiting agents, opioid antagonists, benzodiazepines and other agents. None of the identified agents reached the level A of scientific evidence, 5 reached level B, 7 level C and 13 level D. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD, although these drugs could alleviate some associated non-specific symptoms, such as insomnia or anxiety. Further controlled clinical trials and meta-analysis are needed to guide clinicians in their search of effective pharmacological alternatives to antidepressants in PTSD.
Prescribing Patterns for Patients With Posttraumatic Stress Disorder
Psychiatric Services, 2003
U nderstanding of the diagnosis and treatment of posttraumatic stress disorder (PTSD) has recently matured to the point that it has been possible to derive treatment guidelines from research evidence. Guidelines developed by the International Society for Traumatic Stress Studies (ISTSS) (1) and derived from surveys of expert clinicians and researchers (2) recommend medication and specific cognitive-behavioral therapies as first-line treatments. The recommendation that selective serotonin reuptake inhibitors (SSRIs) be used as first-line medication treatment is supported by large multicenter randomized controlled trials (3-6) that led to the approval of sertraline and paroxetine for PTSD by the U.S. Food and Drug Administration (FDA). Smaller randomized controlled trials had previously supported the efficacy of the traditional categories of antidepressant medications-tricyclics and monoamine oxidase inhibitors (MAOIs)-for the treatment of PTSD (7,8). These agents are not recommended as first-line options in PTSD guidelines (1,2), principally because of their side effect profiles and because of safety concerns. Rather, these and other medications are recommended as second-line strategies-treatments that can be substituted for or added to first-line interventions when the initial clinical response is inadequate or when tolerability is an issue. Second-line medication interventions for PTSD, apart from traditional antidepressants, include novel antidepressants other than the SSRIs-for example, nefazodone, bupropion, and mirtazepine-and mood stabilizers. Support for the use of these agents is not considered as compelling as that for the first-line agents, because evidence of efficacy typically falls short of the standard of randomized controlled trials (1). The one published randomized controlled trial of benzodiazepines for the treatment of PTSD did not support efficacy (9). Adverse consequences of benzodiazepine treatment among patients with PTSD have been reported (10), and their use for PTSD is not recommended by the ISTSS guidelines (1). The newer an
Non-Antidepressant Long-Term Treatment in Post-Traumatic Stress Disorder (PTSD)
Current clinical pharmacology, 2013
Introduction: Post-traumatic stress disorder (PTSD) is a frequent and disabling condition that occurs after exposure to a traumatic event, and Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line treatment approach for this disorder. However, a large proportion of patients remain symptomatic and other pharmacological agents have been investigated, based on the understanding of the underlying biological dysfunctions of PTSD. Methods: We conducted a review of the literature on the pharmacological options for PTSD other than the antidepressants, using MedLine and Web of Science databases, with search terms including the pharmacologic class of each agent plus PTSD, or pharmacotherapy, or fear conditioning. The literature review covered articles published until august 2012, including reviews and original articles. Results: Agents like antipsychotics, anticonvulsants, benzodiazepines, anti-adrenergic agents, have been studied in randomized clinical trials (RCTs), ...
Reflections on active ingredients in efficient treatments of PTSD, Part 1
Traumatology, 1996
This two-part essay summarizes the therapeutic procedures presented at The Active Ingredients in Efficient Treatments of PTSD Conference at Florida State University, May 12-13, 1995, and delineates some possible salient changeproducing ingredients germane to these approaches.