Psychotherapeutic and adjunctive pharmacologic approaches to treating posttraumatic stress disorder (original) (raw)
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Pharmacotherapeutic treatment of nightmares and insomnia in posttraumatic stress disorder
2006
Sleep disturbances are hallmark symptoms of posttraumatic stress disorder (PTSD). Where the subjective experience of nightmares and insomnia in PTSD patients is very real indeed and demands treatment, objective research findings on disordered sleep architecture in PTSD are inconclusive and inconsistent. After reviewing the literature an insufficient number of controlled studies are published to formulate evidence-based guidelines. Several studies have methodological limitations, such as small group sizes and heterogenic samples. Large randomized controlled trials (RCTs) need to be conducted in order to further develop adequate therapeutic interventions. Objective parameters for insomnia and nightmares need to be identified for understanding underlying mechanisms of disturbed sleep in PTSD, and for evaluating therapy.
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.
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.
Efficacy of Adjunct Sleep Interventions for PTSD (EASI-PTSD)
2010
This is the final report for this study. We have completed all pre-and post assessment in all participants randomized to prazosin, placebo, or the behavioral sleep intervention. Two participants are currently completing the 4-month follow-up period. Data analysis for the acute treatment phase is currently underway, and the final analyses (which include 4-month follow-up data) will be initiated shortly. Recruitment has been more difficult than anticipated, but our enrollment rate (10% of individuals who completed the initial screening) is consistent with other ongoing studies in this population. Over the course of the performance period to date, this award has produced a numver of reportable outcomes, including several scientific, peer-review presentations and sumposia, and provided preliminary data for three successful applications for federal funding by the PI, Dr. Ger main. 15. SUBJECT TERMS Sleep, PTSD, post-deployment adjustment disorders, prazosin, behavioral treatments of nightmares and insomnia. 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON
Annals of the New York Academy of Sciences, 2006
Sleep disturbances are hallmark symptoms of posttraumatic stress disorder (PTSD). Where the subjective experience of nightmares and insomnia in PTSD patients is very real indeed and demands treatment, objective research findings on disordered sleep architecture in PTSD are inconclusive and inconsistent. After reviewing the literature an insufficient number of controlled studies are published to formulate evidence-based guidelines. Several studies have methodological limitations, such as small group sizes and heterogenic samples. Large randomized controlled trials (RCTs) need to be conducted in order to further develop adequate therapeutic interventions. Objective parameters for insomnia and nightmares need to be identified for understanding underlying mechanisms of disturbed sleep in PTSD, and for evaluating therapy.
2020
At some point, all of the types of psychotropic medication have been used to treat PTSD. Evidence, however, supports the use of only two very different categories of medication in treating PTSD – SSRI/SNRI antidepressants (selegiline, paroxetine, and venlafaxine) and antihypertensives affecting the catecholamine system (prazosin and propranolol). Other agents having proven effectiveness in treating common comorbid diagnoses (e.g., insomnia and depression) are often useful in treating PTSD. But there is very little evidence indicating any effectiveness for many of the drugs and medications used historically, and are still being used, to treat patients with PTSD. Some of these agents have significant side effects (e.g., benzodiazepines can exacerbate the response to trauma, suppress natural capacities to cope with stress, and induce disinhibition). Many induce significant daytime sleepiness after use (e.g., antipsychotics, sedatives, sedating antidepressants, and anticonvulsants). Som...
Pharmacological treatment of post-traumatic stress disorder
Advances in Psychiatric Treatment, 2007
Post-traumatic stress disorder (PTSD) causes significant distress and is often associated with markedly reduced functioning. Recent reviews have consistently recommended trauma-focused psychological therapies as a first-line treatment for PTSD. Pharmacological treatments have also been recommended but not as consistently. This article reviews the available trials of the pharmacological treatment of PTSD and discusses their implications.
American Journal of Internal Medicine
Post-traumatic stress disorder (PTSD) is a severe anxiety disorder with clinical and social repercussions. The first line of treatment is psychotherapy, but the most advanced forms require, in addition, a drug treatment. Currently, the treatments used are few in number and not very effective. The objective is to review the recent literature on curative drug treatments for PTSD. We conducted a literature review on the Medline database to include articles less than 10 years old dealing with curative drug treatments for PTSD. We identified inclusion and exclusion criteria to frame our research. We first selected articles by reading the title, then the abstract, and finally the full text. Each clinical study was placed in a table with its main characteristics and then analyzed in order to determine the effectiveness of the treatment studied. 51 references were included. Beta-blockers, corticosteroids and D-cycloserine show positive results in combination with various psychotherapy methods. Antiepileptics, oxytocin, atypical antipsychotics and prazosin showed divergent results. The use of prazosin, currently used to treat PTSD-induced sleep disorders, is being questioned. Ketamine, MDMA and cannabinoids have shown satisfactory results in terms of efficacy, but the question of their safety of use remains. The risks of overdose and illegal use should not be overlooked. Molecules such as ketamine, MDMA or cannabinoids will require further studies to conclude their efficacy and safety. They appear to be the most promising molecules currently available for the treatment of PTSD.