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Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines

  • Jonathan Davidson (a1)
Summary

This article discusses the study of Harpaz-Rotem and associates, who examined patterns of medication use in first-diagnosed veterans with post-traumatic stress disorder (PTSD). It considers the difference between practice guidelines and actual prescribing; selectively identifies issues with antidepressants, antipsychotics, benzodiazepines and prazosin; and reviews the possible impact of new medications in the pipeline.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Corresponding author
Jonathan Davidson, 3068 Baywood Drive, Seabrook Island, SC 29455, USA. Email: david011@mc.duke.edu
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Declaration of interests

In the past 36 months, J.D. has received compensation for consulting with Edgemont, Turing and Tonix Pharmaceuticals; royalties in connection with publications by Springer, Guilford and McFarland Publishers and use of the Connor-Davidson Resilience Scale, Davidson Trauma Scale, Social Phobia Inventory (SPIN) and Mini-SPIN; service on the INTRuST Data Safety and Monitoring Board, University of California, San Diego.

Footnotes
References
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1 Harpaz-Rotem, I, Rosenheck, R, Mohamed, S, Pietrzak, R, Hoff, R. Initiation of pharmacotherapy for post-traumatic stress disorder among Iraq and Afghanistan veterans: a dimensional, symptom cluster approach. Br J Psych Open 2016; 2: 286–93.
2 VA/DoD Clinical Practice Guideline: Management of Post-Traumatic Stress. Guideline Summary. US Department of Veterans Affairs and the Department of Defense, 2010.
3 Martenyi, F, Brown, EB, Zhang, H, Prakash, A, Koke, SC. Fluoxetine vs placebo in posttraumatic stress disorder. J Clin Psychiatry 2002; 63: 199206.
4 Panahi, Y, Moghaddam, BR, Sahebkar, A, Nazari, MA, Beirhagdar, F, Karami, G, et al. A randomized, double-blind, placebo-controlled trial on the efficacy and tolerability of sertraline in Iranian veterans with post-traumatic stress disorder. Psychological Med 2011; 41: 2159–66.
5 Davidson, JRT. Vintage treatments for PTSD: a reconsideration of tricyclic drugs. J Psychopharmacol 2015; 29: 264–9.
6 Yehuda, R, Hoge, CW. Treatment options for veterans with PTSD – Reply. JAMA Psychiatry 2016; 73: 758.
7 Steenkamp, MM. Treatment options for veterans with PTSD. JAMA Psychiatry 2016; 73: 757–8. doi: 10.1001/jamapsychiatry.2016.0573.
8 Bernardy, NC, Lund, BC, Alexander, B, Friedman, MJ. Prescribing trends in veterans with posttraumatic stress disorder. J Clin Psychiatry 2012; 73: 297303.
9 Villareal, G, Hamner, MB, Canive, JM, Robert, S, Calais, LA, Durklaski, V, et al. Efficacy of quetiapine monotherapy in posttraumatic stress disorder: a randomized, placebo-controlled trial. Am J Psychiatry 15 July 2016 (doi: 10.1176/appi.ajp.2016.15070967).
10 Pollack, MH, Hoge, EA, Worthington, JJ, Moshier, SJ, Wechsler, RS, Brandes, M, et al. Eszopiclone for the treatment of posttraumatic stress disorder and associated insomnia: a randomized, placebo-controlled trial. J Clin Psychiatry 2011; 72: 8997.
11 Davidson, JRT, Brady, KT, Mellman, TA, Stein, MB, Pollack, MH. The efficacy and tolerability of tiagabine in a population with post-traumatic stress disorder. J Clin Psychopharmacol 2007; 27: 85–8.
12 Brady, KT, Sonne, S, Anton, R, Randall, CN, Back, SE, Simpson, K. Sertraline in the treatment of co-occurring alcohol dependence and posttraumatic stress disorder. Alcohol Clin Exp Res 2005; 29: 395401.
13 Petrakis, IL, Ralevski, E, Desai, N, Trevisan, L, Gueorgieva, R, Rounsaville, B, et al. Noradrenergic vs. serotonergic antidepressant with or without naltrexone for veterans with PTSD and comorbid alcohol dependence. Neuropsychopharmacology 2012; 37: 9961004.
14 Hoskins, M, Pearce, J, Bethell, A, Dankova, L, Barbui, C, Tol, WA, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and metaanalysis. Br J Psychiatry 2015; 206: 93100.
15 Raskind, MA, Peterson, K, Williams, T, Hoff, DJ, Hart, K, Holmes, H, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170: 1003–10.
16 Cooperative Studies Program #563 – Prazosin and Combat Trauma PTSD (PACT). Study Results (https://clinicaltrials.gov/ct2/show/results/NCT00532493?sect=Xba9870156#outcome5)
17 IOM (Institute of Medicine). Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. National Academies Press, 2014.
18 Baldwin, DS, Anderson, IM, Nutt, DJ, Allgulander, C, Bandelow, B, den Boer, JA, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2006 guidelines from the British Association of Psychopharmacology. J Psychopharmacology 2014; 28: 403–39.
19 National Collaborating Centre for Mental Health. Post-traumatic Stress Disorder: the Management of PTSD in Adults and Children in Primary and Secondary Care. NICE Clinical Guidelines (CG26). NICE, 2005.
20 International Society for Traumatic Stress Studies (ISTSS). Effective Treatments for PTSD: Practice Guidelines for the International Society of Traumatic Stress Studies. Guilford Press, 2009.
21 World Health Organization (WHO). Guidelines for the Management of Conditions Specifically Related to Stress (www.who.int/mental_health/resources/emergencies). WHO, 2013.
22 Bandelow, B, Zohar, J, Hollander, E, Kasper, S, Möller, HJ, WFSBP Task Force on Treatment Guidelines for Anxiety, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders – first revision. World J Biol Psychiatry 2008; 9: 248312.
23 Davidson, JRT, Bernik, M, Connor, KM, Friedman, MJ, Jobson, K, Kim, Y, et al. A new treatment algorithm for posttraumatic stress disorder. Psychiatr Ann 2005; 35: 887902.
24 Fontana, A, Rosenheck, R. Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment. Am J Psychiatry 1997; 154: 758–65.
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Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines

  • Jonathan Davidson (a1)
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