Pharmacologic Treatment of Posttraumatic Stress Disorder: A Focus on Antipsychotic Use

Abstract

To review the literature on the pharmacologic treatment of posttraumatic stress disorder (PTSD), with a focus on reports of antipsychotic use for this illness. A MEDLINE search (1966-Oct 2002) for English only articles about pharmacologic treatment of PTSD. Antipsychotic medications are being used with some frequency for PTSD. There are few studies and scant evidence to recommend the traditional antipsychotics. There are a number of reports (mostly case reports and open trials) in which atypical antipsychotics improved sleep and decreased the frequency of nightmares and flashbacks. Some studies showed global improvement across symptom clusters. The newer atypical antipsychotics show promise for the treatment of PTSD, mainly ameliorating intrusive symptoms. The paucity of double-blind studies prevents firm conclusions, however, this class of medications may be useful particularly for refractory symptoms.

A Brief Screening Instrument to Detect Posttraumatic Stress Disorder in Outpatient Gynecology

“…Current treatment strategies for PTSD include psychotherapy (cognitive-behavioral therapy, exposure therapies, dynamic psychotherapies) and psychopharmacology (including selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants, and atypical antipsychotics). [31][32][33][34] However, only the selective serotonin reuptake inhibitors have been proven effective and safe in long-term randomized controlled trials. 31 Thus, the findings of this study suggest that asking women about a history of a traumatic event is extremely important, because this question alone is quite predictive in detecting psychiatric illness that is often untreated.…”

Correlates and Treatments of Nightmares in Adults

“…Atypical antipsychotic drugs have also been tested in the treatment of PTSD-related nightmares in military veterans with PTSD. Studies conducted with respirodone, olanzapine and quetiapine have yielded mixed results89–91. Zolpidem (nonbenzodiazepine imidazopyridine;92), gabapentin93, and mirtazapine94 show some promise, but await more rigorous evaluation.…”

Psychopharmacotherapy of Posttraumatic Stress Disorder

“…If administered as a monotherapy or in combination with other psychotropic drugs, atypical antipsychotic drugs seem to be effective in the treatment of PTSD refractory to other agents or combined with psychotic symptoms (119)(120)(121). They were also shown effective in reducing PTSD symptoms in Croatian war veterans with psychotic characteristics of either depressive or schizophrenic type (84)(85)(86).…”