Antipsicóticos, anticonvulsivantes, antiadrenérgicos e outras drogas: o que fazer quando o transtorno do estresse pós-traumático não responde aos inibidores seletivos da recaptação da serotonina?

Abstract

Antipsychotics, anticonvulsants, antiadrenergic agents and other drugs: what to do when posttraumatic stress disorder does not respond to selective serotonin reuptake inhibitors? Antipsicóticos, anticonvulsivantes, antiadrenérgicos e outras drogas: o que fazer quando o transtorno do estresse pós-traumático não responde aos inibidores seletivos da recaptação da serotonina?A b s t r a c t Objectives: In this narrative review, we aimed to describe different pharmacological strategies for the treatment of patients with posttraumatic stress disorder who display different levels of intolerance, resistance, and refractoriness to the treatment, or who are unable to take to antidepressants, especially serotonin reuptake inhibitors. Method: We searched the ISI Web of Science and PubMed databases for original studies focusing on the treatment of posttraumatic stress disorder in different clinical scenarios.Results: Preliminary evidence pointed towards the efficacy of drugs such as risperidone, olanzapine, lamotrigine and prazosin as strategies to be employed in the above mentioned clinical scenarios. The choice of a specific "second line" drug should take into account not only symptoms, but also patterns of comorbidities, previous response to other treatments, pharmacological interactions, side-effects, and the patient's physical conditions. Conclusions: Future randomized controlled trials should be performed in order to unveil which drugs should be prescribed in the absence of adequate treatment and response to serotonin reuptake inhibitors.Descriptors: Stress disorders, posttraumatic; Pharmacology; Clinical protocols; Review of the literature Resumo Objetivos: Nesta revisão narrativa, o objetivo foi descrever as opções farmacológicas para o tratamento do transtorno de estresse pós-traumático nos casos de intolerância, resistência, refratariedade ou impossibilidade de utilizar antidepressivos, especialmente inibidores seletivos da recaptação da serotonina. Método: Consulta às bases de dados ISI Web of Science e PubMed em busca de estudos originais sobre o tratamento farmacológico do transtorno de estresse pós-traumático em diferentes cenários clínicos. Resultados: Evidências preliminares apontam para a utilidade de drogas como a risperidona, a olanzapina, a lamotrigina e o prazosin como estratégias para o cenário clínico em tela. A escolha do medicamento de segunda linha deve levar em conta não só os sintomas, como também as comorbidades, os tratamentos prévios, as interações farmacológicas, os efeitos colaterais e as condições físicas do paciente. Conclusões: Futuros ensaios clínicos randomizados ainda são necessários para estabelecer com clareza alternativas farmacológicas aos antidepressivos para o tratamento do transtorno de estresse pós-traumático.

Comparative Efficacy and Acceptability of Pharmaceutical Management for Adults With Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis

“…The NICE guideline (Excellence NIfHaC, 2018) also pointed out the potential role of atypical antipsychotics for the treatment of PTSD. A study (Berger et al, 2007) showed that atypical antipsychotics may be an alternative when PTSD does not respond to SSRIs. Veterans with comorbidity of PTSD (McCauley et al, 2012) are more difficult to treat than nonveterans patients; they have higher suicide attempts and worse treatment adherence (McCauley et al, 2012;Reisman, 2016).…”

“…Especially for veterans, common drugs may not be suitable for patients who are resistant to common psychotropic substances, such as SSRIs. Atypical antipsychotics can be used as a strategy for clinical application (Berger et al, 2007). In the future, making great progress in pharmacological treatments of PTSD may need to be researched for some special drugs that have strong effect values from small sample studies.…”

Key Clinical Interest Outcomes of Pharmaceutical Administration for Veterans With Post-Traumatic Stress Disorder Based on Pooled Evidences of 36 Randomised Controlled Trials With 2,331 Adults

“…Unlike fluoxetine, paroxetine, sertraline and venlafaxine recommended in APA and NICE guidelines (Health, 2005;Association, 2017) or previous study (Berger et al, 2007), this study recommended that the risperidone is used as the first-line treatment for veterans. The AAS not only has excellent therapeutic effect, but also has few side effects.…”