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SSRIs versus Non-SSRIs in Post-traumatic Stress Disorder

An Update with Recommendations

Drugs volume 64, pages 383–404 (2004)Cite this article

Abstract

Post-traumatic stress disorder (PTSD) is a highly prevalent (7.8% lifetime rate) anxiety disorder with impairment in daily functioning, frequent suicidal behaviour and high rates of co-morbidity. Fortunately, PTSD is responsive to pharmacotherapy and psychotherapy.

The selective serotonin reuptake inhibitors (SSRIs) are the most studied medications for PTSD, with the largest number of double-blind, placebo-controlled trials. Of the SSRIs, sertraline, paroxetine and fluoxetine have been the most extensively studied, with sertraline and paroxetine being US FDA-approved for PTSD. These studies have demonstrated that SSRIs are effective in short-term trials (6–12 weeks). Furthermore, continuation and maintenance treatment for 6–12 months decrease relapse rates. Besides being the most studied and effective drugs for PTSD, SSRIs have a favourable adverse effect profile, making them the first-line treatment for PTSD. If SSRIs are not tolerated or are ineffective, non-SSRIs should be considered.

Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone and mirtazapine, have been evaluated in PTSD only in open-label and case studies. Because of their promising results and relatively good safety profile, they should be considered as second-line treatment.

Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) have both been evaluated in a small number of double-blind, placebo-controlled studies. The results have been inconsistent but promising. In the limited comparative studies, MAOIs appeared superior to TCAs but patients continued to have residual symptoms. These drugs have significant adverse effects, such as cardiovascular complications, and safety issues, such as ease of overdose. Therefore, TCAs and MAOIs should be considered as third-line treatment.

Anticonvulsants have been evaluated in PTSD in open-label studies and results have been positive for carbamazepine, valproic acid, topiramate and gabapentin. A small double-blind, placebo-controlled study demonstrated efficacy of lamotrigine for PTSD. Anticonvulsants should be considered where co-morbidity of bipolar disorder exists, and where impulsivity and anger predominate. Bupropion (amfebutamone), a predominantly noradrenergic reuptake inhibitor, was ineffective in PTSD in an open-label study. Benzodiazepines were ineffective in a double-blind, placebo-controlled study despite encouraging case reports. They should be avoided or used only short term because of potential depressogenic effects, and the possibility that they may promote or worsen PTSD. Buspirone, a non-benzodiazepine anxiolytic, was found to be effective in PTSD only in open-label studies. Recently, atypical antipsychotics were as effective as monotherapy and as an augmenter to SSRIs in open-label/case studies and small double-blind, placebo-controlled trials; atypical antipsychotics should be considered in PTSD where paranoia or flashbacks are prominent and in potentiating SSRIs in refractory cases.

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References

  1. Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995 Dec; 52(12): 1048–60

    Article  PubMed  CAS  Google Scholar 

  2. Malik ML, Connor KM, Sutherland SM, et al. Quality of life and posttraumatic stress disorder: a pilot study assessing changes in SF-36 scores before and after treatment in a placebo-controlled trial of fluoxetine. J Trauma Stress 1999 Apr; 12(2): 387–93

    Article  PubMed  CAS  Google Scholar 

  3. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 2000; 61 Suppl. 5: 4–12

    Google Scholar 

  4. Solomon SD, Davidson JRT. Trauma: prevalence, impairment, service use, and cost. J Clin Psychiatry 1997; 58 Suppl. 9: 5–11

    Google Scholar 

  5. Amaya-Jackson L, Davidson JR, Hughes DC, et al. Functional impairment and utilization of services associated with posttraumatic stress in the community. J Trauma Stress 1999 Oct; 12(4): 709–24

    Article  PubMed  CAS  Google Scholar 

  6. Breslau N. Outcomes of posttraumatic disorder. J Clin Psychiatry 2001; 62 Suppl. 17: 55–9

    Google Scholar 

  7. Weisberg RB, Bruce SE, Machan JT, et al. Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv 2002 Jul; 53(7): 848–54

    Article  PubMed  Google Scholar 

  8. Davidson JRT, Hughes DC, Blazer DG, et al. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 1991 Aug; 21(3): 713–21

    Article  PubMed  CAS  Google Scholar 

  9. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999 Jul; 56(7): 617–26

    Article  PubMed  CAS  Google Scholar 

  10. Asnis GM, Friedman TA, Sanderson WC, et al. Suicidal behaviors in adult psychiatric outpatients. I: description and prevalence. Am J Psychiatry 1993 Jan; 150(1): 108–12

    CAS  Google Scholar 

  11. Brady KT. Posttraumatic stress disorder and comorbidity: recognizing the many faces of PTSD. J Clin Psychiatry 1997; 58 Suppl. 9: 12–5

    Google Scholar 

  12. Brady KT, Killeen TK, Brewerton T, et al. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry 2000; 61 Suppl. 7: 22–32

    Google Scholar 

  13. Samson AY, Bensen S, Beck A. Posttraumatic stress disorder in primary care. J Fam Pract 1999; 48: 222–7

    PubMed  CAS  Google Scholar 

  14. Davidson JR, Connor KM. Management of posttraumatic stress disorder: diagnostic and therapeutic issues. J Clin Psychiatry 1999; 60 Suppl. 18: 33–8

    Google Scholar 

  15. Marshall RD, Olfson M, Hellman F, et al. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry 2001 Sep; 158(9): 1467–73

    Article  PubMed  CAS  Google Scholar 

  16. American Psychiatric Association. American Psychiatric Association, Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th rev. ed. Washington, DC: American Psychiatric Association, 2000

    Google Scholar 

  17. Stahl SM. Essential psycopharmacology: neuroscientific basis and practical applications. 2nd ed. Cambridge: Cambridge University Press, 2000

    Google Scholar 

  18. Hurst M, Lamb HM. Fluoxetine: a review of its use in anxiety disorders and mixed anxiety and depression. CNS Drugs 2000 Jul; 14(1): 51–80

    Article  CAS  Google Scholar 

  19. McDougle CJ, Southwick SM, Charney DS, et al. An open trial of fluoxetine in the treatment of posttraumatic stress disorder. J Clin Psychopharmacol 1991 Oct; 11(5): 325–7

    PubMed  CAS  Google Scholar 

  20. Nagy LM, Morgan III CA, Southwick SM, et al. Open prospective trial of fluoxetine for posttraumatic stress disorder. J Clin Psychopharmacol 1993 Apr; 13(2): 107–13

    Article  PubMed  CAS  Google Scholar 

  21. March JS. Fluoxetine and fluvoxamine in PTSD [letter]. Am J Psychiatry 1992 Mar; 149(3): 413

    PubMed  CAS  Google Scholar 

  22. Folnegovic-Smalc V, Folnegovic Z, Henigsberg N, et al. Efficacy of fluoxetine in PTSD patients [abstract]. Biol Psychiatry 1997 Jul 1; 42 Suppl. 15: 32S

    Article  Google Scholar 

  23. van der Kolk BA, Dreyfuss D, Michaels M, et al. Fluoxetine in posttraumatic stress disorder. J Clin Psychiatry 1994 Dec; 55(12): 517–22

    PubMed  Google Scholar 

  24. Hertzberg MA, Feldman ME, Beckham JC, et al. Lack of efficacy for fluoxetine in PTSD: a placebo controlled trial in combat veterans. Ann Clin Psychiatry 2000 Jun; 12(2): 101–5

    PubMed  CAS  Google Scholar 

  25. Reist C, Kauffmann CD, Haier RJ, et al. A controlled trial of desipramine in 18 men with posttraumatic stress disorder. Am J Psychiatry 1989 Apr; 146(4): 513–6

    PubMed  CAS  Google Scholar 

  26. Zohar J, Amital D, Miodownik C, et al. Double-blind placebo-controlled pilot study of sertraline in military veterans with posttraumatic stress disorder. J Clin Psychopharmacol 2002 Apr; 22(2): 190–5

    Article  PubMed  CAS  Google Scholar 

  27. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder: randomised, double-blind study. Br J Psychiatry 1999 Jan; 175: 17–22

    Article  PubMed  CAS  Google Scholar 

  28. Martenyi F, Brown EB, Zhang H, et al. Fluoxetine versus placebo in posttraumatic stress disorder. J Clin Psychiatry 2002 Mar; 63(3): 199–206

    Article  PubMed  CAS  Google Scholar 

  29. Martenyi F, Brown EB, Zhang H, et al. Fluoxetine vs placebo in prevention of relapse in post-traumatic stress disorder. Br J Psychiatry 2002 Oct; 181: 315–20

    Article  PubMed  Google Scholar 

  30. Comer AM, Figgitt DP. Sertraline: a review of its therapeutic use in post-traumatic stress disorder. CNS Drugs 2000 Nov; 14(5): 391–407

    Article  CAS  Google Scholar 

  31. Brady KT, Sonne SC, Roberts JM. Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence. J Clin Psychiatry 1995 Nov; 56(11): 502–5

    PubMed  CAS  Google Scholar 

  32. Rothbaum B, Ninan PT, Thomas L. Sertraline in the treatment of rape victims with posttraumatic stress disorder. J Trauma Stress 1996; 9: 865–71

    Article  PubMed  CAS  Google Scholar 

  33. Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA 2000 Apr 12; 283(14): 1837–44

    Article  PubMed  CAS  Google Scholar 

  34. Davidson JR, Rothbaum BO, van der Kolk B A, et al. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 2001 May; 58(5): 485–92

    Article  PubMed  CAS  Google Scholar 

  35. Londborg PD, Hegel MT, Goldstein S, et al. Sertraline treatment of posttraumatic stress disorder: results of 24 weeks of open-label continuation treatment. J Clin Psychiatry 2001 May; 62(5): 325–31

    Article  PubMed  CAS  Google Scholar 

  36. Paykel ES. Continuation and maintenance therapy in depression. Br Med Bull 2001; 57: 145–59

    Article  PubMed  CAS  Google Scholar 

  37. Simon NM, Safren SA, Otto MW, et al. Longitudinal outcome with pharmacotherapy in a naturalistic study of panic disorder. J Affect Disord 2002 May; 69(1–3): 201–8

    Article  PubMed  Google Scholar 

  38. Davidson J, Pearlstein T, Londborg P, et al. Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study. Am J Psychiatry 2001 Dec; 158(12): 1974–81

    Article  PubMed  CAS  Google Scholar 

  39. Dunbar GC, Fuell DL. The anti-anxiety and anti-agitation effects of paroxetine in depressed patients. Int Clin Psychopharmacol 1992 Jun; 6(4 Suppl.): 81–90

    Article  PubMed  Google Scholar 

  40. Marshall RD, Schneier FR, Fallon BA, et al. An open trial of paroxetine in patients with noncombat-related, chronic posttraumatic stress disorder. J Clin Psychopharmacol 1998 Feb; 18(1): 10–8

    Article  PubMed  CAS  Google Scholar 

  41. Tucker P, Zaninelli R, Yehuda R, et al. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry 2001 Nov; 62(11): 860–8

    Article  PubMed  CAS  Google Scholar 

  42. Marshall RD, Beebe KL, Oldam M, et al. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry 2001 Dec; 158(12): 1982–8

    Article  PubMed  CAS  Google Scholar 

  43. Figgitt DP, McClellan KJ. Fluvoxamine: an updated review of its use in the management of adults with anxiety disorders. Drugs 2000 Oct; 60(4): 925–54

    Article  PubMed  CAS  Google Scholar 

  44. Escalona R, Canive JM, Calais LA, et al. Fluvoxamine treatment in veterans with combat-related post-traumatic stress disorder. Depress Anxiety 2002; 15(1): 29–33

    Article  PubMed  Google Scholar 

  45. De Boer M, Op den Velde W, Falger PJ, et al. Fluvoxamine treatment for chronic PTSD: a pilot study. Psychother Psychosom 1992; 57(4): 158–63

    Article  PubMed  Google Scholar 

  46. Marmar CR, Schoenfeld F, Weiss DS, et al. Open trial of fluvoxamine treatment for combat-related posttraumatic stress disorder. J Clin Psychiatry 1996; 57 Suppl. 8: 66–70

    Google Scholar 

  47. Davidson JR, Weisler RH, Malik M, et al. Fluvoxamine in civilians with posttraumatic stress disorder. J Clin Psychopharmacol 1998 Feb; 18(1): 93–5

    Article  PubMed  CAS  Google Scholar 

  48. Hyttel J, Arnt J, Sanchez C. The pharmacology of citalopram. Rev Contemp Pharmacother 1995; 6: 271–85

    CAS  Google Scholar 

  49. Stahl SM. Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline. Biol Psychiatry 2000 Nov 1; 48(9): 894–901

    Article  PubMed  CAS  Google Scholar 

  50. Pollock BG. Citalopram: a comprehensive review. Expert Opin Pharmacother 2001 Apr; 2(4): 681–98

    Article  PubMed  CAS  Google Scholar 

  51. Seedat S, Stein DJ, Ziervogel C, et al. Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2002 Spring; 12(1): 37–46

    Article  PubMed  Google Scholar 

  52. Burke WJ. Escitalopram. Expert Opin Investig Drugs 2002 Oct; 11(10): 1477–86

    Article  PubMed  CAS  Google Scholar 

  53. Southwick SM, Bremner JD, Rasmusson A, et al. Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry 1999 Nov 1; 46(9): 1192–204

    Article  PubMed  CAS  Google Scholar 

  54. Robinson D, Roberts DL, Smith JM, et al. The safety profile of nefazodone. J Clin Psychiatry 1996; 57 Suppl. 2: 31–8

    Google Scholar 

  55. Zajecka J. The effect of nefazodone on comorbid anxiety symptoms associated with depression: experience in family practice in psychiatric outpatient settings. J Clin Psychiatry 1996; 57 Suppl. 2: 10–4

    Google Scholar 

  56. Hidalgo R, Hertzberg MA, Mellman T, et al. Nefazodone in post-traumatic stress disorder: results from six open-label trials. Int Clin Psychopharmacol 1999 Mar; 14(2): 61–8

    Article  PubMed  CAS  Google Scholar 

  57. Hertzberg MA, Feldman ME, Beckham JC, et al. Open trial of nefazodone for combat-related posttraumatic stress disorder. J Clin Psychiatry 1998 Sep; 59(9): 460–4

    Article  PubMed  CAS  Google Scholar 

  58. Zisook S, Chentsova-Dutton YE, Smith-Vaniz A, et al. Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry 2000 Mar; 61(3): 203–8

    Article  PubMed  CAS  Google Scholar 

  59. Preskorn SH. Antidepressant drug selection: criteria and options. J Clin Psychiatry 1994 Sep; 55 Suppl. A: 6–22

    PubMed  Google Scholar 

  60. Sinajkic A, Weine S, Djuric-Bijedic Z, et al. Sertraline, paroxetine, and venlafaxine in refugee posttraumatic disorder with depression symptoms. J Traumatic Stress 2001; 14(3): 445–52

    Article  Google Scholar 

  61. Hamner MB, Freuh BC. Response to venlafaxine in previously antidepressant treatment-resistant combat veteran with posttraumatic stress disorder. Int Clin Psychopharmacol 199; 13: 233–4

  62. Nierenberg AA, Adler LA, Pesselow E, et al. Trazodone for antidepressant-associated insomnia. Am J Psychiatry 1994 Jul; 151(7): 1069–72

    PubMed  CAS  Google Scholar 

  63. Menza MA. Withdrawal syndrome in a depressed patient treated with trazodone [letter]. Am J Psychiatry 1986 Sep; 143(9): 1195

    PubMed  CAS  Google Scholar 

  64. Hargrave R. Serotonergic agents in the management of dementia and posttraumatic stress disorder. Psychosomatics 1993 Sep–Oct; 34(5): 461–2

    Article  PubMed  CAS  Google Scholar 

  65. Hertzberg MA, Feldman ME, Beckham JC, et al. Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design. J Clin Psychopharmacol 1996 Aug; 16(4): 294–8

    Article  PubMed  CAS  Google Scholar 

  66. de Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry 1996; 57 Suppl. 4: 19–25

    PubMed  Google Scholar 

  67. Connor KM, Davidson JR, Weisler RH, et al. A pilot study of mirtazapine in post-traumatic stress disorder. Int Clin Psychopharmacol 1999; 14: 29–31

    Article  PubMed  CAS  Google Scholar 

  68. Hogben GL, Cornfield RB. Treatment of traumatic war neurosis with phenelzine. Arch Gen Psychiatry 1981 Apr; 38(4): 440–5

    Article  PubMed  CAS  Google Scholar 

  69. Walker JL. Chemotherapy of traumatic war stress. Mil Med 1982; 147: 1029–33

    PubMed  CAS  Google Scholar 

  70. Davidson J, Walker JI, Kilts C. A pilot study of phenelzine in the treatment of post-traumatic stress disorder. Br J Psychiatry 1987 Feb; 150: 252–5

    Article  PubMed  CAS  Google Scholar 

  71. Lerer B, Bleich BA, Kotier M, et al. Posttraumatic stress disorder in Israeli combat veterans: effect of phenelzine treatment. Arch Gen Psychiatry 1987 Nov; 44(11): 976–81

    Article  PubMed  CAS  Google Scholar 

  72. DeMartino R, Mollica RF, Wilk V. Monoamine oxidase inhibitors in posttraumatic stress disorder: promise and problems in Indochinese survivors of trauma. J Nerv Ment Dis 1995 Aug; 183(8): 510–5

    Article  PubMed  CAS  Google Scholar 

  73. Neal LA, Shapland W, Fox C. An open trial of moclobemide in the treatment of post-traumatic stress disorder. Int Clin Psychopharmacol 1997 Jul; 12(4): 231–7

    Article  PubMed  CAS  Google Scholar 

  74. Shestatzky M, Greenberg D, Lerer B. A controlled trial of phenelzine in posttraumatic stress disorder. Psychiatry Res 1988 May; 24(2): 149–55

    Article  PubMed  CAS  Google Scholar 

  75. Kosten TR, Frank JB, Dan E, et al. Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. J Nerv Ment Dis 1991 Jun; 179(6): 366–70

    Article  PubMed  CAS  Google Scholar 

  76. Baker DG, Diamond BI, Gillette G, et al. A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology (Berl) 1995 Dec; 122(4): 386–9

    Article  CAS  Google Scholar 

  77. Katz RJ, Lott MH, Arbus P, et al. Pharmacotherapy of posttraumatic stress disorder with a novel psychotropic. Anxiety 1994–95; 1 (4): 169–74

  78. Burstein A. Treatment of post-traumatic stress disorder with imipramine. Psychosomatics 1984 Sep; 25(9): 681–7

    Article  PubMed  CAS  Google Scholar 

  79. Falcon S, Ryan C, Chamberlain K, et al. Tricyclics: possible treatment for posttraumatic stress disorder. J Clin Psychiatry 1985 Sep; 46(9): 385–8

    PubMed  CAS  Google Scholar 

  80. Kauffman CD, Reist C, Djenderedjian A, et al. Biological markers of affective disorders and posttraumatic stress disorder: a pilot study with desipramine. J Clin Psychiatry 1987 Sep; 48(9): 366–7

    PubMed  CAS  Google Scholar 

  81. Davidson J, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry 1990 Mar; 47(3): 259–66

    Article  PubMed  CAS  Google Scholar 

  82. Southwick SM, Krystal JH, Bremner JD, et al. Noradrenergic and serotonergic function in posttraumatic stress disorder. Arch Gen Psychiatry 1997 Aug; 54(8): 749–58

    Article  PubMed  CAS  Google Scholar 

  83. Segman RH, Cooper-Kazaz R, Macciardi F, et al. Association between the dopamine transporter gene and posttraumatic stress disorder. Mol Psychiatry 2002; 7(8): 903–7

    Article  PubMed  CAS  Google Scholar 

  84. Canive JM, Clark RD, Calais LA, et al. Bupropion treatment in veterans with posttraumatic stress disorder: an open study. J Clin Psychopharmacol 1998 Oct; 18(5): 379–83

    Article  PubMed  CAS  Google Scholar 

  85. Hertzberg MA, Moore SD, Feldman ME, et al. A preliminary study of bupropion sustained-release for smoking cessation in patients with chronic posttraumatic stress disorder. J Clin Psychopharmacol 2001 Feb; 21(1): 94–8

    Article  PubMed  CAS  Google Scholar 

  86. Bleich A, Siegel B, Garb R, et al. Post-traumatic stress disorder following combat exposure: clinical features and psychopharmacological treatment. Br J Psychiatry 1986 Sep; 149: 365–9

    Article  PubMed  CAS  Google Scholar 

  87. Feldmann TB. Alprazolam in the treatment of posttraumatic stress disorder. J Clin Psychiatry 1987 May; 48(5): 216–7

    PubMed  CAS  Google Scholar 

  88. Lowenstein RJ, Hornstein N, Farber B. Open trial of clonazepam in the treatment of posttraumatic stress symptoms in multiple personality disorder. Dissociation 1988; 1: 3–12

    Google Scholar 

  89. Braun BP, Greenberg D, Dasberg DH, et al. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry 1990 Jun; 51(6): 236–8

    PubMed  CAS  Google Scholar 

  90. Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry 1996 Sep; 57(9): 390–4

    PubMed  CAS  Google Scholar 

  91. Mellman TA, Bustamante V, David D, et al. Hypnotic medication in the aftermath of trauma. J Clin Psychiatry 2002 Dec; 63(12): 1183–4

    Article  PubMed  Google Scholar 

  92. Duffy JD, Malloy PF. Efficacy of buspirone in the treatment of posttraumatic stress disorder: an open trial. Ann Clin Psychiatry 1994 Mar; 6(1): 33–7

    Article  PubMed  CAS  Google Scholar 

  93. Fichtner CG, Crayton JW. Buspirone in combat-related posttraumatic stress disorder. J Clin Psychopharmacol 1994 Feb; 14(1): 79–81

    PubMed  CAS  Google Scholar 

  94. Bartolomeil F, Guye M, Wendling F, et al. Fear, anger and compulsive behavior during seizure: involvement of large scale fronto-temporal neural networks. Epileptic Disord 2002 Dec; 4(4): 235–41

    PubMed  Google Scholar 

  95. Swann AC. Neuroreceptor mechanisms of aggression and its treatment. J Clin Psychiatry 2003; 64 Suppl. 4: 26–35

    Google Scholar 

  96. Post RM, Weiss SR, Smith M, et al. Kindling versus quenching: implications for the evolution and treatment of posttraumatic stress disorder. Ann N Y Acad Sci 1997 Jun 21; 821: 285–95

    Article  PubMed  CAS  Google Scholar 

  97. Lipper S, Davidson JRT, Grady TA, et al. Preliminary study of carbamazepine in post-traumatic stress disorder. Psychosomatics 1986 Dec; 27(12): 849–54

    Article  PubMed  CAS  Google Scholar 

  98. Fesler FA. Valproate in combat-related posttraumatic stress disorder. J Clin Psychiatry 1991 Sep; 52(9): 361–4

    PubMed  CAS  Google Scholar 

  99. Berlant J, van Kammen DP. Open-label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: a preliminary report. J Clin Psychiatry 2002 Jan; 63(1): 15–20

    Article  PubMed  CAS  Google Scholar 

  100. Pollack MH, Matthews J, Scott EL. Gabapentin as a potential treatment for anxiety disorders. Am J Psychiatry 1998 Jul; 155(7): 992–3

    PubMed  CAS  Google Scholar 

  101. Hammer MB, Brodrick PS, Labbate LA. Gabapentin in PTSD: a retrospective, clinical series of adjunctive therapy. Ann Clin Psychiatry 2001; 13: 141–6

    Google Scholar 

  102. Berigan TR. Gabapentin in the treatment of posttraumatic stress disorder: a case report [letter]. Primary Care Companion J Clin Psychiatry 2000; 2: 105

    Article  PubMed  Google Scholar 

  103. Brannon N, Labbate L, Huber M. Gabapentin treatment for posttraumatic stress disorder [letter]. Can J Psychiatry 2000 Feb; 45(1): 84

    PubMed  CAS  Google Scholar 

  104. Hertzberg MA, Butterfield MI, Feldman ME, et al. A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biol Psychiatry 1999 May 1; 45(9): 1226–9

    Article  PubMed  CAS  Google Scholar 

  105. Dillard ML, Bendfeldt F, Jernigan P. Use of thioridazine in posttraumatic stress disorder. South Med J 1993 Nov; 86(11): 1276–8

    Article  PubMed  CAS  Google Scholar 

  106. Hamner MB. Clozapine treatment for a veteran with comorbid psychosis and PTSD [letter]. Am J Psychiatry 1996 Jun; 153(6): 841

    PubMed  CAS  Google Scholar 

  107. Petty F, Brannan S, Casada J, et al. Olanzapine treatment for post-traumatic stress disorder: an open-label study. Int Clin Psychopharmacol 2001 Nov; 16(6): 331–7

    Article  PubMed  CAS  Google Scholar 

  108. Hamner MB, Faldowski RA, Ulmer HG, et al. Adjunctive risperidone treatment in post-traumatic stress disorder: a preliminary controlled trial of effects on comorbid psychotic symptoms. Int Clin Psychopharmacol 2003 Jan; 18(1): 1–8

    Article  PubMed  CAS  Google Scholar 

  109. Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 2002 Oct; 159(10): 1777–9

    Article  PubMed  Google Scholar 

  110. Hamner MB, Deitsch SE, Brodrick PS, et al. Quetiapine treatment in patients with posttraumatic stress disorder: an open trial of adjunctive therapy. J Clin Psychopharmacol 2003 Feb; 23(1): 15–20

    Article  PubMed  CAS  Google Scholar 

  111. Harmon RJ, Riggs PD. Clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 1996 Sep; 35(9): 1247–9

    Article  PubMed  CAS  Google Scholar 

  112. Raskind MA, Dobie DJ, Kanter ED, et al. The alphal-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases. J Clin Psychiatry 2000 Feb; 61(2): 129–33

    Article  PubMed  CAS  Google Scholar 

  113. Famularo R, Kinscherff R, Fenton T. Propranolol treatment for childhood posttraumatic stress disorder, acute type: a pilot study. Am J Dis Child 1988 Nov; 142(11): 1244–7

    PubMed  CAS  Google Scholar 

  114. Foa EB, Davidson JRT, Frances A. The expert consensus guideline series: treatment of posttraumatic stress disorder: The Expert Consensus Panels for PTSD. J Clin Psychiatry 1999; 60 Suppl. 16: 1–75

    Google Scholar 

  115. Ballenger JC, Davidson JRT, Lecrubier Y, et al. Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 2000; 61 Suppl. 5: 60–6

    Google Scholar 

  116. Roose SP, Spatz E. Treatment of depression in patients with heart disease. J Clin Psychiatry 1999; 60 Suppl. 20: 34–7

    Google Scholar 

  117. Marmar CR, Neylan TC, Schoenfeld FB. New directions in the pharmacotherapy of posttraumatic stress disorder. Psychiatr Q 2002 Winter; 73(4): 259–70

    Article  PubMed  Google Scholar 

  118. Southwick SM, Yehuda R, Geller EL. Use of tricyclics and monoamine oxidase inhibitors in the treatment of PTSD: a quantitative review. In: Marburg MM, editor. Catecholamine function in post-traumatic disorder: emerging concepts. Washington, DC: American Psychiatric Press, 1994: 293–305

    Google Scholar 

  119. Livingston MG, Livingston HM. Monoamine oxidase inhibitors: an update on drug interactions. Drug Saf 1996 Apr; 14(4): 219–27

    Article  PubMed  CAS  Google Scholar 

  120. Nelson JC, Kennedy JS, Pollock BG, et al. Treatment of major depression with nortriptyline and paroxetine in patients with ischemic heart disease. Am J Psychiatry 1999 Jul; 156(7): 1024–8

    PubMed  CAS  Google Scholar 

  121. Kusumakar V. Antidepressants and antipsychotics in the long-term treatment of bipolar disorder. J Clin Psychiatry 2002 Nov; 63(10 Suppl.): 23–8

    PubMed  CAS  Google Scholar 

  122. Martin R, Kuzniecky R, Ho S, et al. Cognitive effects of topiramate, gabapentin, and lamotrigine in healthy young adults. Neurology 1999 Jan; 52(2): 321–7

    Article  PubMed  CAS  Google Scholar 

  123. Goldberg JF, Burdick KE. Cognitive side effects of anticonvul-sants. J Clin Psychiatry 2001; 62 Suppl. 14: 27–33

    Google Scholar 

  124. Aldenkamp AP, Arends J, Bootsma HP, et al. Randomized double-blind parallel-group study comparing cognitive effects of a low-dose lamotrigine with valproate and placebo in healthy volunteers. Epilepsia 2002 Dec; 43(1): 19–26

    Article  PubMed  CAS  Google Scholar 

  125. Calabrese JR, Sullivan JR, Bowden CL, et al. Rash in multicenter trials of lamotrigine in mood disorders: clinical relevance and management. J Clin Psychiatry 2002 Nov; 63(11): 1012–9

    Article  PubMed  Google Scholar 

  126. Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Onlin J 2002 Jun; 8(1): 5 [online]. Available from URL: http://dermatology.cdlib.org/DOJvol8numl/reviews/drugrxn/ghislain.html [Accessed 2004 Jan 20]

    Google Scholar 

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Acknowledgements

Professor Asnis has received grants from Pfizer, GlaxoSmithKline, Wyeth and Sepracor and has lectured for Pfizer, GlaxoSmithKline, Hoffman La Roche and Sanofi Synthelabo. The remaining authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.

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  1. Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, 10467, USA

    Gregory M. Asnis, Shari R. Kohn, Margaret Henderson & Nicole L. Brown

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  1. Gregory M. Asnis
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  2. Shari R. Kohn
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  3. Margaret Henderson
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  4. Nicole L. Brown
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Correspondence to Gregory M. Asnis.

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Asnis, G.M., Kohn, S.R., Henderson, M. et al. SSRIs versus Non-SSRIs in Post-traumatic Stress Disorder. Drugs 64, 383–404 (2004). https://doi.org/10.2165/00003495-200464040-00004

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  • DOI: https://doi.org/10.2165/00003495-200464040-00004

Keywords

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Venlafaxine
  • Nefazodone