Skip to main content
SpringerLink
Log in

Pharmacologic Treatment of PTSD

  • Chapter
  • First Online:
Post-Traumatic Stress Disorder

Abstract

There has been a welcome increase of pharmacologic randomized controlled trials (RCTs) for post-traumatic stress disorder (PTSD) during the past two decades. Progress clearly has been made toward a rational psychopharmacology of PTSD, but recommendations of authoritative practice guidelines as well as prescribing patterns, especially for military veterans with chronic PTSD, often appear disconnected from evidence obtained from these RCTs. Furthermore, an Institute of Medicine assessment found the existing evidence inadequate to determine efficacy of any drug or drug class for PTSD. This chapter reviews data from the more informative PTSD drug RCTs, the rationale for potential efficacy of the drug classes evaluated, and the implications of the evidence available for clinicians who must decide how to prescribe for the patients in their practices.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kulka, R., Fairbank, J., Jordan, K. B., and Weiss, D. (1990) Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Routledge.

    Google Scholar 

  2. Neylan, T. C., Marmar, C. R., Metzler, T. J., Weiss, D. S., Zatzick, D. F., Delucchi, K. L., et-al. (1998) Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatry 155:929–33.

    PubMed  CAS  Google Scholar 

  3. Breslau, N., Davis, G. C., Andreski, P., and Peterson, E. (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48:216–22.

    PubMed  CAS  Google Scholar 

  4. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., and Nelson, C. B. (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–60.

    PubMed  CAS  Google Scholar 

  5. American Psychiatric Association. (2004) Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Washington, DC: American Psychiatric Press.

    Google Scholar 

  6. VA (Veterans Affairs), DoD (Department of Defense), Management of Post-Traumatic Stress Working Group. (2004) VA/DoD Clinical Practice Guideline for the Management of Posttraumatic stress. Version 1.0. Washington, DC: Department of Veterans Affairs and Department of Defense.

    Google Scholar 

  7. Friedman, M. J., Marmar, C. R., Baker, D. G., Sikes, C. R., and Farfel, G. M. (2007) Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs Setting. J Clin Psychiatry 68:711–20.

    PubMed  CAS  Google Scholar 

  8. Mohamed, S., and Rosenheck, R. (2008) Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection. J Clin Psychiatry 69:959–65.

    Google Scholar 

  9. Institute of Medicine. (2008) Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence. Washington, DC: National Academies Press.

    Google Scholar 

  10. Glavin, G. B. (1985) Stress and brain noradrenaline: a review. Behav Neurosci Rev 9:233–43.

    CAS  Google Scholar 

  11. Yehuda, R., Southwick, S., Giller, E. L., Ma, X., and Mason, J. W. (1992) Urinary catecholamine excretion and severity of PTSD symptoms in Vietnam combat veterans. J Nerv Ment Dis 180:321–25.

    PubMed  CAS  Google Scholar 

  12. Geracioti, T. D., Jr, Baker, D. G., Ekhator, N. N., West, S. A., Hill, K. K., Bruce, A. B., Schmidt, D., Rounds-Kugler, B., Yehuda, R., Keck, P. E., Jr, and Kasckow, J. W. (2001) CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry 158:1227–30.

    PubMed  Google Scholar 

  13. Liberzon, I., Abelson, J. L., Flagel, S. B., Raz, J., and Young, E. A. (1999) Neuroendocrine and psychophysiologic responses in PTSD: a symptom provocation study. Neuropsychopharmacology 21:40–50.

    PubMed  CAS  Google Scholar 

  14. Mellman, T. A., Kumar, A., Kulick-Bell, R., Kumar, M., and Nolan, R. (1995) Nocturnal/daytime urine noradrenergic measures and sleep in combat-related PTSD. Biol Psychiatry 38:174–79.

    PubMed  CAS  Google Scholar 

  15. McFall, M. E., Murburg, M. M., Ko, G. N., and Veith, R. C. (1990) Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder. Biol Psychiatry 27:1165–75.

    PubMed  CAS  Google Scholar 

  16. Pitman, R. K., Orr, S. P., Forgue, D. F., deJong, J. B., and Claiborn, J. M. (1987) Psychophysiologic assessment of posttraumatic stress disorder in Vietnam combat veterans. Arch Gen Psychiatry 44:970–75.

    PubMed  CAS  Google Scholar 

  17. Southwick, S. M., Krystal, J. H., Morgan, A., Johnson, D., Nagy, L. M., Nicolaou, A., Heninger, G. R., Charney, D. S. (1993) Abnormal noradrenergic function in posttraumatic stress disorder. Arch Gen Psychiatry 50:266–74.

    PubMed  CAS  Google Scholar 

  18. Reist, C., Duffy, J. G., Fujimoto, K., and Cahill, L. (2001) β-Adrenergic blockade and emotional memory in PTSD. Int J Neuropsychopharmacol 4:377–83.

    PubMed  CAS  Google Scholar 

  19. Woodward, S. H., Arsenault, N. J., Murray, C., and Bliwise, D. L. (2000) Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol Psychiatry 48:1081–87.

    PubMed  CAS  Google Scholar 

  20. Mallick, B. N., Majumdar, S., Faisal, M., Yadav, V., Madan, V., and Pal, D. (2002) Role of norepinephrine in the regulation of rapid eye movement sleep. J Biosci 27:539–51.

    PubMed  CAS  Google Scholar 

  21. Vythilingam, M., Anderson, G. M., Owens, M. J., Halaszynski, T. M., Bremner, J. D., Carpenter, L. L., Heninger, G. R., Nemeroff, C. B., and Charney, D. S. (2000) Cerebrospinal fluid corticotrophin-releasing hormone in healthy humans: effects of yohimbine and naloxone. J Clin Endocrinol Metab 85:4138–45.

    PubMed  CAS  Google Scholar 

  22. Koob, G. F. (1999) Corticotropin-releasing factor, norepinephrine, and stress. Biol Psychiatry 46:1167–80.

    PubMed  CAS  Google Scholar 

  23. Birnbaum, S., Gobeske, K. T., Auerbach, J., Taylor, J. R., and Arnsten, A. F. (1999) A role for norepinephrine in stress-induced cognitive deficits: alpha-1 adrenoreceptor mediations in the prefrontal cortex. Biol Psychiatry 46:1266–74.

    PubMed  CAS  Google Scholar 

  24. Westfall, T. C., and Westfall, D. P. (2006) Adrenergic agonists and antagonists. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill, pp. 237–95.

    Google Scholar 

  25. Cleland, J. G. (2003) β-Blockers for heart failure: why, which, when, and where. Med Clin North Am 87:339–71.

    Google Scholar 

  26. Cooper, K. L., McKiernan, J. M., and Kaplan, S. A. (1999) α-Adrenoreceptor antagonists in the treatment of benign prostatic hyperplasia. Drugs 57:9–17.

    PubMed  CAS  Google Scholar 

  27. MacMillan, L. B., Hein, L., Smith, M. S., Piascik, M. T., and Limbird, L. E. (1996) Central hypotensive effects of the α2A-adrenergic receptor subtype. Science 273:801–3.

    PubMed  CAS  Google Scholar 

  28. Kinzie, J. D., and Leung, P. (1989) Clonidine in Cambodian patients with posttraumatic stress disorder. J Nerv Ment Dis 177:546–50.

    PubMed  CAS  Google Scholar 

  29. Kolb, L. C., Burris, B. C., and Griffiths, S. (1984) Propranolol and clonidine in the treatment of posttraumatic stress disorders of war. In: van der Kolk, B. A., ed., Posttraumatic Stress Disorder: Psychological and Biological Sequelae. Washington, DC: American Psychiatric Press, pp. 98–105.

    Google Scholar 

  30. Kinzie, J. D., Sacks, R. L., and Riley, C. M. (1994) The polysomnographic effects of clonidine on sleep disorders in posttraumatic stress disorders: a pilot study with Cambodian patients. J Nerv Ment Dis 182:585–87.

    PubMed  CAS  Google Scholar 

  31. Neylan, T. C., Lenoci, M., Samuelson, K. W., Metzler, T. J., Henn-Haase, C., Hierholzer, R. W., Lindley, S. E., Otte, C., Schoenfeld, F. B., Yesavage, J. A., and Marmar, C. A. (2006) No improvement of posttraumatic stress disorder symptoms with guanfacine treatment. Am J Psychiatry 163:2186–88.

    PubMed  Google Scholar 

  32. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., and Keane, T. M. (1995) The development of a clinician administered PTSD scale. J Trauma Stress 8:75–90.

    PubMed  CAS  Google Scholar 

  33. Davis, L. L., Ward, C., Rasmusson, A., Newell, J. M., Frazier, E., and Southwick, S. M. (2008) A placebo-controlled trial of guanfacine for the treatment of posttraumatic stress disorder in veterans. Psychopharm Bull 41:8–18.

    Google Scholar 

  34. Medical Economics Company. (2008) Physicians Desk Reference. 62nd ed. Montvale, NJ: Medical Economics.

    Google Scholar 

  35. Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., Cahill, L., and Orr, S. P. (2002) Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry 51:189–92.

    PubMed  CAS  Google Scholar 

  36. Stein, M. B., Kerridge, C., Dimsdale, J. E., and Hoyt, D. B. (2007) Pharmacotherapy to prevent PTSD: results from a randomized controlled proof-of-concept trial in physically injured patients. J Trauma Stress 20:923–32.

    PubMed  Google Scholar 

  37. Menkes, D. B., Baraban, J. M., and Aghajanian, G. K. (1981) Prazosin selectively antagonizes neuronal responses mediated by alpha-1 adrenoreceptors in brain. Naunyn Schmiedebergs Arch Pharmacol 317:273–75.

    PubMed  CAS  Google Scholar 

  38. Cecchi, M., Khoshbouei, H., Javors, M., and Morilak, D. A. (2002) Modulatory effects of norepinephrine in the lateral bed nucleus of the stria terminalis on behavioral and neuroendocrine response to acute stress. Neuroscience 112:13–21.

    PubMed  CAS  Google Scholar 

  39. Weathers, F. W., Litz, B. T., Herman, J. A., Huska, J. A., and Keane, T. M. (1993) The PTSD Checklist: reliability, validity, and diagnostic utility. Presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX, October 24–27.

    Google Scholar 

  40. Raskind, M. A., Peskind, E. R., Kanter, E. D., Petrie, E. C., Radant, A., Thompson, C. E., Dobie, D. J., Hoff, D., Rein, R. J., Straits-Tröster, K., Thomas, R. G., and McFall, M. E. (2003) Reduction in nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry 160:371–73.

    PubMed  Google Scholar 

  41. Guy, W. (1976) Assessment Manual for Psychopharmacology. Washington, DC: U.S. Department of Health, Education and Welfare. Publication (ADM) 76-338 NIMH, pp. 218–22.

    Google Scholar 

  42. Raskind, M. A., Peskind, E. R., Hoff, D. J., Hart, K. L., Holmes, H. A., Warren, D., Shofer, J., O'Connell, J., Taylor, F., Gross, C., Rohde, K., and McFall, M. E. (2007) A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with posttraumatic stress disorder. Biol Psychiatry 61:928–34.

    PubMed  CAS  Google Scholar 

  43. Taylor, F. B., Martin, P., Thompson, C., Williams, J., Mellman, T. A., Gross, C., Peskind, E. R., and Raskind, M. A. (2008) Prazosin effects on sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry 63:629–32.

    PubMed  CAS  Google Scholar 

  44. Mellman, T. A., Knorr, B. R., Pigeon, W. R., Leiter, J. C., and Akay, M. (2004) Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biol Psychiatry 55:953–56.

    PubMed  Google Scholar 

  45. Baldessarini, R. J. (2006) Drug therapy of depression and anxiety disorders. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill, pp. 429–59.

    Google Scholar 

  46. Baldessarini, R. J., and Tarazi, F. I. (2006) Pharmacotherapy of psychosis and mania. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill, pp. 461–500.

    Google Scholar 

  47. American Diabetes Association. (2004) Consensus development conference on antipsychotic drugs and obesity in diabetes. Diabetes Care 27:596–601.

    Google Scholar 

  48. Rasmussen, D.A., Alexander, L.L., Raskind, M.A., and Froehlich, J.C. (Submitted). The α1-adrenergic receptor antagonist, prazosin, reduces alcohol drinking in alcohol-preferring (P).

    Google Scholar 

  49. Walker, B. M., Rasmussen, D. D., Raskind, M. A., and Koob, G. F. (2008) The effects of α1-noradrenergic receptor antagonism on dependence-induced increases in responding for ethanol. Alcohol 42:91–97.

    PubMed  CAS  Google Scholar 

  50. Simpson, T. L., Meredith, C. W., Gross, C. A., Raskind, M. A., and Saxon, A. J. (2007) Pilot trial of prazosin for treatment of alcohol dependence. Alcohol Clin Exp Res 31 (suppl):60A.

    Google Scholar 

  51. Loscher, W. (1999) Valproate: a reappraisal of its pharmacodynamic properties and mechanism of action. Prog Neurobiol 58:31–59.

    PubMed  CAS  Google Scholar 

  52. Pollack, M. H., Roy-Byrne, P. P., Van Ameringen, M., et-al. (2005) The selective GABA reuptake inhibitor tiagabine for the treatment of generalized anxiety disorder: results of a placebo-controlled study. J Clin Psychiatry 66:1401–8.

    PubMed  CAS  Google Scholar 

  53. Herrero, A. I., Olmo, N., Gonzales-Escalada, J. R., et-al. (2002) Two new actions of topiramate: inhibition of depolarizing GABA(A)-mediated responses and activation of a potassium conductance. Neuropharmacology 42:210–20.

    PubMed  CAS  Google Scholar 

  54. Vaiva, G., Thomas, P., Ducrocq, F., Fontaine, M., Boss, V., Devos, P., Rascle, C., Cottencin, O., Brunet, A., Laffargue, P., and Goudemand, M. (2004) Low posttrauma GABA plasma levels as a predictive factor in the development of acute posttraumatic stress disorder. Biol Psychiatry 55:250–54.

    PubMed  CAS  Google Scholar 

  55. Bremner, J. D., Innis, R. B., Southwick, S. M., Staib, L., Zoghbi, S., and Charney, D. S. (2000) Decreased benzodiazepine receptor binding in prefrontal cortex in combat-related posttraumatic stress disorder. Am J Psychiatry 157:1120–26.

    PubMed  CAS  Google Scholar 

  56. Geuze, E., van Berckel, B. N. M., Lammertsma, A. A., Boellard, R., de Kloet, C. S., Vermetten, E., and Westenberg, H. G. M. (2008) Reduced GABAA benzodiazepine receptor binding in veterans with posttraumatic stress disorder. Mol Psychiatry 13:74–83.

    PubMed  CAS  Google Scholar 

  57. Fujita, M., Southwick, S. M., Denucci, C. C., Zoghbi, S. S., Dillon, M. S., Baldwin, R. M., et-al. (2004) Central type benzodiazepine receptors in Gulf War veterans with posttraumatic stress disorder. Biol Psychiatry 56:95–100.

    PubMed  CAS  Google Scholar 

  58. Post, R. M., Ballenger, J. C., Putnam, F. M., and Bunney, W. F. (1983) Carbamazepine in alcohol withdrawal syndromes. J Clin Psychopharmacol 3:204–5.

    PubMed  CAS  Google Scholar 

  59. Davis, L. L., Davidson, J. R. T., Ward, C., Bartolucci, A., Bowden, C. L., and Petty, F. (2008) Divalproex in the treatment of posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial in a veteran population. J Clin Psychopharmacol 28:84–88.

    PubMed  CAS  Google Scholar 

  60. Davidson, J. R. T., Brady, K., Mellman, T. A., Stein, M. B., and Pollack, M. H. (2007) The efficacy and tolerability of tiagabine in adult patients with posttraumatic stress disorder. J Clin Psychopharmacol 27:85–88.

    PubMed  CAS  Google Scholar 

  61. Tucker, P., Trautman, R. P., Wyatt, D. B., Thompson, J., Wu, S.-C., Capece, J. A., and Rosenthal, N. R. (2007) Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 68:201–6.

    PubMed  CAS  Google Scholar 

  62. Davis, D., Kutcher, G. S., Jackson, E. I., and Mellman, T. A. (1999) Psychotic symptoms in combat-related posttraumatic stress disorder. J Clin Psychiatry 60:29–32.

    Google Scholar 

  63. Butterfield, M. I., Becker, M. E., Connor, K. M., Sutherland, S., Churchill, L. E., and Davidson, J. R. T. (2001) Olanzapine in the treatment of posttraumatic stress disorder: a pilot study. Int Clin Psychopharmacol 16:197–203.

    PubMed  CAS  Google Scholar 

  64. Stein, M. B., Kline, N. A., and Matloff, J. L. (2002) Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 159:1777–79.

    PubMed  Google Scholar 

  65. Hamner, M. B., Faldowski, R. A., Ulmer, H. G., Frueh, B. C., Huber, M. G., and Arana, G. W. (2003). Adjunctive risperidone treatment in posttraumatic stress disorder: a preliminary controlled trial in effects on comorbid psychotic symptoms. Int Clin Psychopharmacol 18:1–8.

    CAS  Google Scholar 

  66. Monnelly, E. P., Ciraulo, D. A., Knapp, C., and Keane, T. (2003) Low-dose risperidone as adjunctive therapy for irritable aggression in posttraumatic stress disorder. J Clin Psychopharmacol 23:193–96.

    PubMed  CAS  Google Scholar 

  67. Bartzokis, G., Lu, P. H., Turner, J., Mintz, J., and Saunders, C. S. (2004) Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder. Biol Psychiatry 57:474–79.

    Google Scholar 

  68. Padala, P. R., Madison, J., Monnahan, M., Marcil, W., Price, P., Ramaswamy, S., Din, A. U., Wilson, D. R., Petty, F. (2006) Risperidone monotherapy for posttraumatic stress disorder related to sexual assault and domestic abuse in women. Int Clin Psychopharmacol 21:275–80.

    PubMed  Google Scholar 

  69. Reich, D. B., Winternitz, S., Hennen, J., Watts, T., and Stanculescu, C. (2004) A preliminary study of risperidone in the treatment of posttraumatic stress disorder related to childhood abuse in women. J Clin Psychiatry 65:1601–6.

    PubMed  CAS  Google Scholar 

  70. Rothbaum, B. O., Killeen, T. K., Davidson, J. R. T., Brady, K. T., Connor, K. M., and Heekin, M. H. (2008) Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor-resistant civilian posttraumatic stress disorder. J Clin Psychiatry February 13:e1–e6, Epub ahead of print.

    Google Scholar 

  71. Robert, S., Hamner, M. B., Chose, S., et-al. (2005) Quetiapine improves sleep disturbances in combat trauma veterans with PTSD: sleep data from a prospective open-label study. J Clin Psychopharmacol 25:387–88.

    PubMed  Google Scholar 

  72. Medina, J. H., Novas, M. L., Wolfman, C. N., Levi de Stein, M., and De Robertis, E. (1983) Benzodiazepine receptors in rat cerebral cortex and hippocampus undergo rapid and reversible changes after acute stress. Neuroscience 9:331–35.

    PubMed  CAS  Google Scholar 

  73. Charney, D. S., Mihic, S. J., and Harris, R. A. Hypnotics and sedatives. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill, pp. 401–27.

    Google Scholar 

  74. Randall, P. K., Bremner, D., Krystal, J. H., Nagy, L. M., Heninger, G. R., Nicolau, A. L., and Charney, D. S. (1995) Effects of the benzodiazepine antagonist flumazenil in PTSD. Biol Psychiatry 38:319–24.

    PubMed  CAS  Google Scholar 

  75. Braun, P. D., Greenberg, D., Dasberg, H., and Lerer, B. (1990) Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry 51:236–38.

    PubMed  CAS  Google Scholar 

  76. Gelpin, E., Bonne, O., Peri, T., Brandes, D., and Shalev, A. Y. (1996) Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry 57:390–94.

    PubMed  CAS  Google Scholar 

  77. Cates, M. E., Bishop, M. H., Davis, L. L., and Woolley, T. W. (2004) Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Ann Pharmacother 38:1395–99.

    PubMed  CAS  Google Scholar 

  78. Davidson, J. R. T. (2004) Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. J Clin Psychiatry 65(suppl 5):29–33.

    PubMed  CAS  Google Scholar 

  79. Arora, R. C., Fichtner, C. G., O'Connor, F., and Crayton, J. W. (1993) Paroxetine binding in the blood platelets of posttraumatic stress disorder patients. Life Sci 53:919–28.

    PubMed  CAS  Google Scholar 

  80. Southwick, S. M., Krystal, J. H., Bremner, D., Morgan, C. A., Nicolaou, A. L., Nagy, L. M., Johnson, D. R., Heninger, G. R., and Charney, D. S. (1997) Noradrenergic and serotonergic function in posttraumatic stress disorder. Arch Gen Psychiatry 54:749–58.

    PubMed  CAS  Google Scholar 

  81. Brady, K., Pearlstein, T., Asnis, G. M., Baker, D., Rothbaum, B., Sikes, C. R., Farfel, G. M. (2002) Efficacy and safety of sertraline treatment of posttraumatic stress disorder. JAMA 283:1837–44.

    Google Scholar 

  82. Davidson, J. R.T., Rothbaum, B. O., van der Kolk, B. A., Sikes, C. R., and Farfel, G. M. (2001) Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 58:485–92.

    PubMed  CAS  Google Scholar 

  83. Marshall, R. D., Beebe, K. L., Oldham, M., and Zaninelli, R. (2001) Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry 158:1982–88.

    PubMed  CAS  Google Scholar 

  84. Tucker, P., Zaninelli, R., Yehuda, R., Ruggiero, L., Dillingham, K., and Pitts, C. D. (2001) Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry 62:860–68.

    PubMed  CAS  Google Scholar 

  85. Van der Kolk, B. A., Dreyfuss, D., Michaels, M., Shera, D., Berkowitz, R., Fisler, R., and Saxe, G. (1994) Fluoxetine in posttraumatic stress disorder. J Clin Psychiatry 55:517–22.

    PubMed  Google Scholar 

  86. Hertzberg, M. A., Feldman, M. E., Beckham, J. C., Kudler, H. S., and Davidson, J. R. T. (2000) Lack of efficacy for fluoxetine in PTSD: a placebo controlled trial in combat veterans. Ann Clin Psychiatry 12:101–5.

    PubMed  CAS  Google Scholar 

  87. Davidson, J. R., Book, S. W., Colket, J. T., Tupler, L. A., Roth, S., David, D., Hertzberg, M., Mellman, T., Beckham, J. C., Smith, R. D., Davison, R. M., Katz, R., and Feldman, M. E. (1997) Assessment of a new self-rating scale for posttraumatic stress disorder. Psychol Med 27:153–60.

    PubMed  CAS  Google Scholar 

  88. Zohar, J., Amital, D., Miodownik, C., Kotler, M., Bleich, A., Lane, R. M., and Austin, C. (2002) Double-blind placebo-controlled study of sertraline in military veterans with posttraumatic stress disorder. J Clin Psychiatry 22:190–95.

    CAS  Google Scholar 

  89. Martenyi, F., and Soldatenkova, V. (2006) Fluoxetine in the acute treatment and relapse prevention of combat-related posttraumatic stress disorder: analysis of the veteran group of a placebo-controlled, randomized clinical trial. Eur Neuropsychopharmacol 16:340–49.

    PubMed  CAS  Google Scholar 

  90. Montgomery, S. A., and Asberg, M. (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–89.

    PubMed  CAS  Google Scholar 

  91. Montgomery, S. A., and Asberg, M. (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–89.

    PubMed  CAS  Google Scholar 

  92. Davidson, J., Baldwin, D., Stein, D. J., Kuper, E., Benattia, I., Ahmed, S., Pedersen, R., and Musgnung, J. (2006) Treatment of posttraumatic stress disorder with venlafaxine extended release. Arch Gen Psychiatry 63:1158–65.

    PubMed  CAS  Google Scholar 

  93. Davidson, J. R. T., Landerman, L. R., Farfel, G. M., and Clary, C. M. (2002) Characterizing the effects of sertraline in posttraumatic stress disorder. Psychol Med 32:661–70.

    PubMed  CAS  Google Scholar 

  94. Meltzer-Brody, S., Connor, K. M., Churchill, E., and Davidson, J. R. T. (2000) Symptom-specific effects of fluoxetine in posttraumatic stress disorder. Int Clin Psychopharmacol 15:227–31.

    PubMed  CAS  Google Scholar 

  95. Stein, D. J., Pederson, R., Rothbaum, B. O., Baldwin, D. S., Ahmed, S., Musgnung, J., and Davidson, J. (2008) Onset of activity and time to response on individual CAPS-SX17 items in patients treated for posttraumatic stress disorder with venlafaxine ER: a pooled analysis. Int J Neuropscychopharmacol 11:1–9.

    Google Scholar 

  96. Obendorfer, S., Saletu-Zyhlarz, G., and Saletu, B. (2000) Effects of selective serotonin reuptake inhibitors on objective and subjective sleep quality. Pharmacopsychiatry 42:69–81.

    Google Scholar 

  97. Hamilton, M. S., and Opler, L. A. (1992) Akathisia, suicidality, and fluoxetine. J Clin Psychiatry 53:401–6.

    PubMed  CAS  Google Scholar 

  98. Shalev, A. (2007) A randomized controlled study of the efficacy of prolonged exposure, cognitive therapy and an SSRI in the prevention of PTSD. Presented at the 23rd International Society for Traumatic Stress Studies Annual Meeting, Baltimore, MD.

    Google Scholar 

  99. Davidson, J., Kudler, H., Smith, R., Mahorney, S. L., Lipper, S., Hammett, E., Saunders, W. B., and Cavenar, J. O. (1990) Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry 47:259–66.

    PubMed  CAS  Google Scholar 

  100. Kosten, T. R., Frank, J. B., Dan, E., McDougle, C. J., and Giller, E. L., Jr (1991) Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. J Nerv Ment Dis 179:366–70.

    PubMed  CAS  Google Scholar 

  101. Schuckit, M., Robins, E., and Feighner, J. (1971) Tricyclic antidepressants and monoamine oxidase inhibitors. Arch Gen Psychiatry 24:509–14.

    PubMed  CAS  Google Scholar 

  102. Hertzberg, M. A., Feldman, M. E., Beckham, J. C., and Davidson, J. R. T. (1996) Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design. J Clin Psychopharmacol 16:294–98.

    PubMed  CAS  Google Scholar 

  103. Davis, L. L., Jewell, M. E., Ambrose, S., Farley, J., English, B., Bartolucci, A., and Petty, F. (2004) A placebo-controlled study of nefazodone for the treatment of chronic posttraumatic stress disorder. J Clin Psychopharmacol 24:291–97.

    PubMed  CAS  Google Scholar 

  104. Davidson, J. R., Weisler, R. H., Butterfield, M. I., Casat, C. D., Connor, M., Barnett, S., and van Meter, S. (2003) Mirtazapine vs. placebo in posttraumatic stress disorder: a pilot trial. Biol Psychiatry 53:188–91.

    CAS  Google Scholar 

  105. Thompson, L. T., Moskal, J. R., and Disterhoft, J. F. (1992) Hippocampus-dependent learning facilitated by a monoclonal antibody or d-cycloserine. Nature 356:638–41.

    Google Scholar 

  106. Rothbaum, B. O. (2008) Critical parameters for d-cycloserine enhancement of cognitive-behavioral therapy for obsessive-compulsive disorder. Editorial. Am J Psychiatry 165:293–96.

    Google Scholar 

  107. Heresco-Levy, U., Kremer, I., Javitt, D. C., Goichman, R., Reshef, A., Blanaru, M., and Cohen, T. (2002) Pilot-controlled trial of d-cycloserine for the treatment of posttraumatic stress disorder. Int J Neuropsychopharmacol 5:301–7.

    PubMed  CAS  Google Scholar 

  108. Bohus, B., Kovacs, G. L., and De Wied, D. (1978) Oxytocin, vasopressin and memory: opposite effects on consolidation and retrieval processes. Brain Res 157:414–17.

    PubMed  CAS  Google Scholar 

  109. Pitman, R. K., Orr, S. P., and Lasko, N. B. (1993) Effects of intranasal vasopressin and oxytocin on physiologic responding during personal combat imagery in Vietnam veterans with posttraumatic stress disorder. Psychiatry Res 48:107–17.

    PubMed  CAS  Google Scholar 

  110. Jacobs-Rebhun, S., Schnurr, P. P., Friedman, M. J., Peck, R., Brophy, M., and Fuller, D. (2000) Posttraumatic stress disorder and sleep difficulty. Am J Psychiatry 157:1525–26.

    PubMed  CAS  Google Scholar 

  111. Baker, D. G., West, S. A., Nicholson, W. E., Ekhator, N. N., Kasckow, J. W., Hill, K. K., Bruce, A. B., Orth, D. N., Geracioti, T. D., Jr (1999) Serial CSF corticotrophin-releasing hormone levels and adrenocortical activity in combat veterans with posttraumatic stress disorder. Am J Psychiatry 156:585–88.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. VA Puget Sound Health Care System, 1660 South Columbian Way, S116-6 East, Seattle, WA 98105

    Murray A. Raskind

Authors
  1. Murray A. Raskind
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

    Rights and permissions

    Reprints and permissions

    Copyright information

    © 2009 Humana Press, a part of Springer Science+Business Media, LLC

    About this chapter

    Cite this chapter

    Raskind, M. (2009). Pharmacologic Treatment of PTSD. In: LeDoux, J., Keane, T., Shiromani, P. (eds) Post-Traumatic Stress Disorder. Humana Press. https://doi.org/10.1007/978-1-60327-329-9_16

    Download citation

    • DOI: https://doi.org/10.1007/978-1-60327-329-9_16

    • Published:

    • Publisher Name: Humana Press

    • Print ISBN: 978-1-60327-328-2

    • Online ISBN: 978-1-60327-329-9

    • eBook Packages: MedicineMedicine (R0)

    Publish with us

    Policies and ethics

    Search

    Navigation