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New Directions in the Pharmacotherapy of Posttraumatic Stress Disorder

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Abstract

Advances in psychopharmacology of PTSD are presented, focusing on antidepressants, adrenergic agents, antianxiety agents, and mood stabilizers. Treatment recommendations are related to recent advances in the understanding of the biology of PTSD. Pharmacotherapy of PTSD in children and adolescents is discussed, including recommended dose ranges. Recommendations are specified for pharmacotherapy of trauma survivors in the immediate aftermath of traumatic exposure, and for those with acute and chronic posttraumatic stress disorders.

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REFERENCES

  1. Neal LA, Shapland W, Fox C: An open trial of moclobemide in the treatment of post-traumatic stress disorder. International Clinical Psychopharmacology 12:231-237, 1997.

    Google Scholar 

  2. Amital D, Zohar J, Bleich A: A placebo-controlled pilot study of sertraline in posstraumatic stress disorder [poster]. Paper presented at Collegium Internationale Neuro-Psychopharmacologicum annual meeting, Brussels, Belgium, 2000.

  3. Davidson JR, Rothbaum BO, van der Kolk BA, Sikes CR, Farfel G: Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Archives of General Psychiatry 58:485-492, 2001.

    Google Scholar 

  4. Brady K, Pearlstein T, Asnis GM, et al: Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. JAMA 283:1837-1844, 2000.

    Google Scholar 

  5. Marmar CR, Schoenfeld FB, Weiss DS, Metzler TJ, Zatzick D, Wu R, et al: Open trial of fluvoxamine treatment for combat-related posttraumatic stress disorder. Journal of Clinical Psychiatry 57(Suppl 8):66-72, 1996.

    Google Scholar 

  6. Neylan TC, Metzler TJ, Schoenfeld FB, Weiss DS, Lenoci M, Best SR, et al: Fluvoxamine and sleep disturbances in posttraumatic stress disorder. Journal of Traumatic Stress 14(3):461-468, 2001.

    Google Scholar 

  7. van der Kolk BA, Dreyfuss D, Michaels M, Shera D, Berkowitz R, Fisler R, et al: Fluoxetine in posttraumatic stress disorder. Journal of Clinical Psychiatry 55:517-522, 1994.

    Google Scholar 

  8. Marshall RD, Schneier FR, Fallon BA, et al: An open trial of paroxetine in patients with noncombat-related, chronic posttraumatic stress disorder. Journal of Clinical Psychopharmacology 18:10-18, 1998.

    Google Scholar 

  9. Beebe K, Pitts C, Ruggiero L, Ramming S, Oldham M, Zaninelli R: Paroxetine in the treatment of PTSD: A 12-week, placebo-controlled, Multicenter Study. Paper presented at ISTSS, San Antonio, TX, 2000.

  10. Londborg PD, Hegel MT, Goldstein S, Goldstein D, Himmelhoch JM, Maddock R, et al: Sertraline treatment of posttraumatic stress disorder: Results of 24 weeks of open-label continuation treatmetns. Journal of Clinical Psychiatry 62(5):325-331, 2001.

    Google Scholar 

  11. Marshall RD, Beebe KL, Oldham M, Zaninelli R: Efficacy and safety of paroxetine treatment for chronic PTSD:Afixed-dose, placebo-controlled study. American Journal of Psychiatry 158(12):1982-1988, 2001.

    Google Scholar 

  12. Londborg P, Patterson W, Hegel M, Sikes C, Farfel G: Results of a 24-week Open-Label Extension Study of Sertraline in PTSD [poster]. Paper presented at American Psychiatric Association, Chicago, 2000.

  13. Rapaport MH, Endicott J, Clary CM: Posttraumatic stress disorder and quality of life: Results across 64 weeks of sertaline treatment. Journal of Clinical Psychiatry 63(1):59-65, 2002.

    Google Scholar 

  14. Davidson J, Pearlstein T, Londborg P, Brady KT, Rothbaum B, Bell J, et al: Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: Results of a 28-week double-blind, placebo-controlled study. American Journal of Psychiatry 158(12):1974-1981, 2001.

    Google Scholar 

  15. Hidalgo R, Hertzberg MA, Mellman T, Petty F, Tucker P, Weisler R, et al: Nefazodone in post-traumatic stress disorder: Results from six open-label trials. International Clinical Psychopharmacology 14(2):61-68, 1999.

    Google Scholar 

  16. Davis LL, Nugent AL, Murray J, Kramer GL, Petty F: Nefazodone treatment for chronic posttraumatic stress disorder: An open trial. Journal of Clinical Psychopharmacology 20:159-164, 2000.

    Google Scholar 

  17. Gillin JC, Smith-Vaniz A, Schnierow B, Rapaport MH, Kelsoe J, Raimo E, et al: An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic Combat-related posttraumatic stress disorder. Journal of Clinical Psychiatry 62(10):789-796, 2001.

    Google Scholar 

  18. Baker DG, Diamond BI, Gillette G, Hamner M, Katzelnick D, Keller T, et al: A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology 122(4):386-389, 1995.

    Google Scholar 

  19. Katz RJ, Lott MH, Arbus P, et al: Pharmacotherapy of post-traumatic stress disorder with a novel psychotropic. Anxiety 1:169-174, 1995.

    Google Scholar 

  20. Hamner MB, Frueh B: Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with post-traumatic stress disorder. International Clinical Psychopharmacol 13:233-234, 1998.

    Google Scholar 

  21. Gelpin E, Bonne O, Peri T, Brandes D, Shalev A: Treatment of recent trauma survivors with benzodiazepines:A prospective study. Journal of Clinical Psychiatry 57:390-394, 1996.

    Google Scholar 

  22. Braun P, Greenberg D, Dasberg H, Lerer B: Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. Journal of Clinical Psychiatry 51:236-238, 1990.

    Google Scholar 

  23. Risse SC, Whitters A, Burke J, Chen S, Scurfield RM, Raskind MA: Severe withdrawal symptoms after discontinuation of alprazolam in eight patients with combat-induced posttraumatic stress disorder. Journal of Clinical Psychiatry 51:206-209, 1990.

    Google Scholar 

  24. Kaplan HI, Sadock B: Synopsis of Psychiatry, 8th edn., Baltimore, MD, Lippincott Williams & Wilkins, 1998.

    Google Scholar 

  25. Duffy JD, Malloy PF: Efficacy of buspirone in the treatment of posttraumatic stress disorder: An open trial. Annals of Clinical Psychiatry 6:33-37, 1994.

    Google Scholar 

  26. Lipper S, Davidson JR, Grady TA, et al: Preliminary study of carbamazepine in posttraumatic stress disorder. Psychosomatics 27:849-854, 1986.

    Google Scholar 

  27. Keck PE, Jr., McElroy SL, Friedman LM: Valproate and carbamazepine in the treatment of panic and posttraumatic stress disorders, withdrawal states, and behavioral dyscontrol syndromes. Journal of Clinical Psychopharmacology 12(1):36S-41S, 1992.

    Google Scholar 

  28. Looff D, Grimley P, Kuller F, Martin A, Shonfield L: Carbamazepine for ptsd [letter]. Journal of the American Academy of Child and Adolescent Psychiatry 34(6):703-704, 1995.

    Google Scholar 

  29. Fesler FA: Valproate in combat-related posttraumatic stress disorder. Journal of Clinical Psychiatry 52:361-364, 1991.

    Google Scholar 

  30. Berlant JvK: Open-label topiramate as primary or adjunctive therapy in chronic civillian posttraumatic stress disorder: A preliminary report. Journal of Clinical Psychiatry 63(1):15-20, 2002.

    Google Scholar 

  31. Forster PL, Schoenfeld FB, Marmar CR, Lang AJ: Lithium for irritability in posttraumatic stress disorder. Journal of Traumatic Stress 8:143-149, 1995.

    Google Scholar 

  32. Petty F, Brannan S, Casada J, LL D, Gajewski V, GL K, et al: Olanzapine treatment for post-traumatic stress disorder: An open-label study. International Clinical Psychopharmacy 16(6):331-337, 2001.

    Google Scholar 

  33. Southwick S, Paige S, Morgan C, Bremner J, Krystal JH, Charney DS: Neurotransmitter alterations in PTSD: Catecholamines and serotonin. Seminar in Clinical Neuropsychiatry 4:242-248, 1999.

    Google Scholar 

  34. Cahill L, Prins B, Weber M, JL. M: Beta-adrenergic activation and memory for emotional events. Nature 371:702-704, 1994.

    Google Scholar 

  35. Pitman RK, Sanders KM, Zusman RM, Healy AR, Cheema F, Lasko NB, et al: Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological Psychiatry 51(2):189-192, 2002.

    Google Scholar 

  36. Famularo R, Kinscherff R, Fenton T: Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. American Journal of Diseased Children 142:1244-1247, 1988.

    Google Scholar 

  37. Friedman MJ, Southwick SM: Towards pharmacotherapy for post-traumatic stress disorder. In: M. J. Friedman, D. S. Charney, and A. Y. Deutch, eds., Neurobiological and Clinical Consequences of Stress: From Normal Adaptation to Post-Traumatic Stress Disorder. Philadelphia, PA, Lippincott-Raven Publishers, 1995, pp. 465-481.

    Google Scholar 

  38. Harmon RJ, Riggs P: Clonidine for posttraumatic stress disorder in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry 35:1247-1249, 1996.

    Google Scholar 

  39. Kinzie JD, Leung P: Clonidine in Cambodian patients with posttraumatic stress disorder. Journal of Nervous Mental Disease 177:546-550, 1989.

    Google Scholar 

  40. Horrigan JP, Barnhill LJ: The suppression of nightmares with guanfacine. Journal of Clinical Psychiatry 57(8):371, 1996.

    Google Scholar 

  41. Mellman TA, David D, Barza L: Nefazodone treatment and dream reports in chronic PTSD. Depression and Anxiety 9:146-148, 1999.

    Google Scholar 

  42. Gupta S, Austin R, Cali LA, Bhatara V: Nightmares treated with cyproheptadine. Journal of the American Academy of Child and Adolescent Psychiatry 37(6):570-571, 1998.

    Google Scholar 

  43. Rijnders R, Laman DM, Van Diujn H: Cyproheptadine for posttraumatic nightmares. American Journal of Psychiatry 157:1524-1525, 2000.

    Google Scholar 

  44. Hamner MB, Brodrick PS, Labbate LA: Gabapentin in PTSD: A retrospective, clinical series of adjunctive therapy. Annals of Clinical Psychiatry 13(3):141-146, 2001.

    Google Scholar 

  45. Raskind M, Dobie D, Kanter E, Petrie E, Thompson C, Peskind E: The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stres disorder: A report of 4 cases. Journal of Clinical Psychiatry 61(2):129-133, 2000.

    Google Scholar 

  46. Donnelly CL, Amaya-Jackson L, March J: Psychopharmacology of pediatric posttraumatic stress disorder. Journal of Child and Adolescent Psychopharmacology 9:203-220, 1999.

    Google Scholar 

  47. Robert R, Blakeney PE, Villarreal C, Rosenberg L, 3rd MW: Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry 38:873-882, 1999.

    Google Scholar 

  48. Shalev AY, Bonne O: Pharmacological treatment of trauma-related disorders. In: Shalev AY, Yehuda R, McFarlane, eds., International Handbook of Human Response to Trauma. New York, Kluwer Academic/Plenum Publishers, 2000, pp. 363-378.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Francisco, California

    Charles R. Marmar, Thomas C. Neylan & Frank B. Schoenfeld

  2. Department of Veterans Affairs Medical Center, San Francisco, California

    Charles R. Marmar

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  1. Charles R. Marmar
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  2. Thomas C. Neylan
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  3. Frank B. Schoenfeld
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Marmar, C.R., Neylan, T.C. & Schoenfeld, F.B. New Directions in the Pharmacotherapy of Posttraumatic Stress Disorder. Psychiatr Q 73, 259–270 (2002). https://doi.org/10.1023/A:1020459916113

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