August 3, 2011
Antidepressants and Post Traumatic Stress Disorder
(Ivanhoe Newswire) -- Patients with military-related, chronic posttraumatic stress disorder (PTSD) and symptoms that were not improved with use of an antidepressant medication did not experience a reduction in PTSD symptoms with use of the antipsychotic medication risperidone, according to this study.
Posttraumatic stress disorder is one of the most common and disabling psychiatric disorders among military personnel serving in combat. Antidepressants are the predominant pharmacotherapy for PTSD, and within the U.S. Department of Veterans Affairs (VA), 89 percent of veterans diagnosed with PTSD and treated with pharmacotherapy are prescribed serotonin reuptake inhibitors (SRIs). "However, SRIs appear to be less effective in men than in women and less effective in chronic PTSD than in acute PTSD. Thus, it may not be surprising that an SRI study in veterans produced negative results. Second-generation antipsychotics (SGAs) are commonly used medications for SRI-resistant PTSD symptoms, despite limited evidence supporting this practice," the authors were quoted as saying.
John H. Krystal, M.D., of the VA Connecticut Healthcare System, West Haven, Conn., and colleagues evaluated whether risperidone (a second-generation antipsychotic often used for the treatment of schizophrenia and bipolar disorder), when added to an ongoing pharmacotherapy regimen would be more effective than placebo for reducing chronic military-related PTSD symptoms among veterans whose symptoms did not respond to at least 2 adequate SRI treatments. The study consisted of a 6-month, randomized, placebo-controlled multicenter trial conducted between February 2007 and February 2010 at 23 Veterans Administration outpatient medical centers. Of the 367 patients screened, 296 were diagnosed with military-related PTSD and had ongoing symptoms despite at least 2 adequate SRI treatments, and 247 contributed to analysis of the primary outcome measure. Patients received risperidone (up to 4 mg once daily) or placebo and other psychosocial mental health therapies. Symptoms of PTSD, depression, anxiety and other health outcomes were gauged via various scales and surveys.
After analysis of the data, the researchers found no statistically significant difference between risperidone and placebo in reducing measures of PTSD symptoms after 6 months of treatment. In addition, risperidone was not statistically superior to placebo on any of the other outcomes, including improvement on measures of quality of life, depression, anxiety, or paranoia/psychosis.
Overall, the rate of adverse events during treatment was low but appeared related to dosing of risperidone.
SOURCE: JAMA, published online August 3, 2011