Quetiapine as an adjunctive treatment for post-traumatic stress disorder: an 8-week open-label study

Abstract

This study evaluated the effectiveness of quetiapine for subjects with post-traumatic stress disorder (PTSD) who were already on a stable dose of a selective serotonin reuptake inhibitor (SSRI) but had significant PTSD symptoms. Fifteen subjects were enrolled in an 8-week open-label trial for PTSD in which quetiapine was added to an SSRI. Subjects were on a stable dose of the SSRI for at least 6 weeks before study entry and had a Clincian-Administered PTSD Scale (CAPS) score of greater than or equal to 50 at study baseline. The mean age of subjects was 49 years (eight men and seven women). The average duration of PTSD was 29 years, one-third of subjects had combat-related PTSD, and two-thirds had noncombat PTSD. The mean dose prescribed in the study was 216 mg per day. The initial median CAPS score was 80, indicating severe PTSD. The addition of a modest dose of quetiapine provided significant relief from PTSD symptoms with a 42% overall improvement in PTSD symptoms based on the CAPS and significant improvement along each dimension of symptoms: re-experiencing (Z=-3.24, P=0.0012), hyperarousal (Z=-3.30, P=0.001) and avoidance (Z=-2.13, P=0.03). Subjects rated themselves as 45% improved on average on the Davidson Trauma Scale and reported a 44% decrease in their level of disability and impairment as reflected by the Sheehan Disability Scale. Subjects with PTSD who had significant PTSD symptoms when on an SSRI benefited from the addition of quetiapine. Patients improved significantly on all three clusters of PTSD symptoms: re-experiencing, hyperarousal and avoidance.

Posttraumatic Stress Disorder: Assessment and Treatment

“…The empirical literature is dominated by case studies/series, nonrandomized, and non-placebo-controlled studies on the use of quetiapine (Ahearn, Mussey, Johnson, Krohn, & Krahn, 2006;Filteau, Leblanc, & Bouchard, 2003;Robert et al, 2005;Hamner, Deitsch, Brodrick, Ulmer, & Lorberbaum, 2003;Sokolski, Denson, Lee, & Reist, 2003;Stathis, Martin, & McKenna, 2005), olanzapine (Butterfield, 2003;Izrayelit, 1998;Jakovljevic,Šagud, & Mihaljevic-Peleš, 2003;Labbate & Douglas, 2000;Petty, Brannan, & Casada, 2001;Pivac, Kozaric-Kovacic, & Mück-Šeler, 2004;Prior, 2001), risperidone (David, De Faria, Lapeyra, & Mellman, 2004;David, De Faria, & Mellman, 2006;Kozaric-Kovacic, Pivac, Mück-Šeler, & Rothbaum, 2005;Krashin & Oates, 1999;Monnelly & Ciraulo, 1999;Monnelly, Ciraulo, Knapp, & Keane, 2003), aripiprazole (Lambert, 2006), ziprasidone (Siddiqui, Marcil, Bhatia, Ramaswamy, & Petty, 2005), and clozapine (Hamner, 1996). To date, there are only a handful of published studies examining the efficacy of atypical antipsychotics utilizing a double-blind, placebo-controlled, and randomized design, and they have focused on risperidone (Bartzokis, Lu, Turner, Mintz, & Saunders, 2005;Hamner, Faldowski, et al, 2003;Monnelly et al, 2003;Reich, Winternitz, Hennen, Watts, & Stanculescu, 2004) and olanzapine (Butterfield et al, 2001;Stein, Kline, & Matloff, 2002).…”

A Review of Interventions for Treatment-Resistant Posttraumatic Stress Disorder

“…All studies demonstrated a significant reduction in CAPS total scores and CAPS subscale scores (avoidance, re-experiencing and hyperarousal). Ahearn et al (2006) found an average final CAPS score of 46, representing a 42% decrease in symptom severity. All three subscales, B, C and D, showed significant reduction as well (23 to 10, 27 to 23 and 26 to 14, respectively).…”

“…Quetiapine use for treating refractory PTSD is shown to be effective in three open-label trials (Ahearn, Mussey, Johnson, Krohn, & Krahn, 2006;M. B. Hamner, Deitsch, Brodrick, Ulmer, & Lorberbaum, 2003;Kozaric-Kovacic & Pivac, 2007).…”

“…Two studies examine quetiapine as an adjunctive therapy to antidepressants or other psychotropics (Hamner, Deitsch et al, 2003) or with SSRIs (Ahearn et al, 2006), whereas Kozaric-Kovacic and Pivac (2007) examine quetiapine as a monotherapy. Resistance to treatment was defined as no change in CAPS scores after two 8-week trials with different antidepressants (KozaricKovacic & Pivac, 2007), incomplete responsiveness to treatment (Hamner, Deitsch et al, 2003) or as still experiencing PTSD symptoms despite being on a stable dose of SSRIs (Ahearn et al, 2006). The CAPS total and subscores are used as primary outcomes in all open label studies.…”

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?

“…[15][16][17] In one of these open studies, it was possible to identify clinical improvement in the second week of treatment. In a series of cases, 18 quetiapine was proven to be efficient to decrease flashbacks in five patients with treatment-refractory PTSD using several classes of drugs.…”