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

Ahearn, Eileen M.; Krohn, Amy; Connor, Kathryn M.; Davidson, Jonathan

doi:10.3109/10401230309085689

Cited by 16 publications

(2 citation statements)

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“…Atypical antipsychotics have been used with some success for nightmares for more than 20 years [84,87]. In the VAMC study, the atypical antipsychotic risperidone had the best success rate (77%) of all the 21 agents prescribed for more than 327 veterans in the VAMC study.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms of action for risperidone for nightmare modulation are thought to include antiserotonergic receptor antagonism and antidopaminergic activity (5-HT 2A, 5-HT7, D2) for anxiety and insomnia [87,97], and alpha-1 and αlpha-2 adrenoreceptors’ ability to decrease sympathetic outflow, resulting in improvement of anxiety, hyperarousal, and irritability symptoms [76,87,97]. Interestingly, the VAMC study success and failure dose ranges were relatively similar: 0.25–5.0 mg compared to 0.25–6.0 mg, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

Detweiler

Pagadala

Candelario

et al. 2016

JCM

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The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.

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Section: Discussionmentioning

confidence: 99%