DOCSLIB.ORG

Management of Adults with PTSD Part II: Drugs and Other Interventions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Adults with PTSD Part II: Drugs and Other Interventions DTB | Lubiprostone for chronic constipation in adults DTB CME/CPD* Management of adults with PTSD part II: drugs and other interventions Exposure to traumatic events is common, and many people experience some symptoms following such exposure. In most people, these symptoms subside within a few weeks, but for others, post-traumatic stress disorder (PTSD) develops and may be long-lasting. Part I of this article (DTB 2014; 52: 33–6) discussed the recognition of PTSD and evidence for trauma- focused psychological treatment (generally considered to be first-line treatment). Here in part II of the article, we discuss other possible second-line options: pharmacological treatments and other therapies. Pharmacological treatment of PTSD • tricyclic antidepressants (TCAs e.g. amitriptyline), • monoamine oxidase (MAO) inhibitors (e.g. phenelzine), • Pharmacological therapies that have been tried for PTSD include: • alpha-blockers (e.g. prazosin), • selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine, sertraline, fluoxetine), • second-generation (atypical) antipsychotics (e.g. risperidone), • serotonin and norepinephrine reuptake inhibitors (SNRIs e.g. venlafaxine), • anticonvulsants (e.g. topiramate), • other second-generation antidepressants (e.g. bupropion, mirtazapine, • benzodiazepines (e.g. alprazolam) and trazodone), • other drugs (e.g. cycloserine).1 The British National Formulary (BNF) suggests that PTSD can be treated with SSRIs (e.g. paroxetine or sertraline).2 The National Institute for Health and Care * DTB CME/CPD A CME/CPD module based on this article is available for completion online via BMJ Excellence (NICE) evidence update of December 2013 notes that fluoxetine, Learning (learning.bmj.com) by subscribers to the online version of DTB. If prompted, venlafaxine, mirtazapine, amitriptyline, phenelzine, risperidone, topiramate, and subscribers must sign into DTB with their username and password. All users must cycloserine do not have UK marketing authorisation for use in PTSD; informed also complete a one-time registration on BMJ Learning and subsequently log in (with consent should be obtained and documented for a drug used off-label.3 Currently, a BMJ Learning username and password) on every visit. The answers to the multiple only paroxetine and sertraline are approved by the US Food and Drug choice questions will be freely available on dtb.bmj.com on publication of the next 1,4,5 issue of DTB. Administration and licensed in Europe for treatment of patients with PTSD. The drugs with UK marketing authorisation for treatment of PTSD are shown in Box 1. 44 | DTB | Vol 52 | No 4 | April 2014 dtb.bmj.com DTB | Management of adults with PTSD part II: drugs and other interventions Box 1: Drugs with UK marketing authorisation Box 2: Outcome rating scales for treatment of PTSD Clinician-Administered PTSD Scale (CAPS): Thirty-item structured Paroxetine—recommended dose is 20mg daily. If, after some weeks interview administered by a trained professional. Corresponds to on the recommended dose, insufficient response is seen, some the DSM-5 criteria for PTSD symptoms, impact on functioning, patients may benefit from having their dose increased gradually in response validity, lifetime diagnosis, and overall PTSD severity. 10mg steps up to a maximum of 50mg/day. Long-term use should be Range: 0–136 regularly evaluated.4 0–19: asymptomatic/few symptoms Sertraline—therapy should be initiated at 25mg daily. After 1 week, the dose should be increased to 50mg once daily. Patients not responding 20–39: mild PTSD/sub-threshold to a 50mg dose may benefit from dose increases. Dose changes should 40–59: moderate PTSD/threshold be made in steps of 50mg at intervals of at least 1 week, up to a maximum of 200mg/day. Changes in dose should not be made more 60–79: severe frequently than once per week given the 24-hour elimination half-life ≥80: extreme PTSD1,7,8 of sertraline.5 Hamilton Depression Rating Scale (HAMD): Seventeen-item clinician administered scale used to measure the severity of depressive In a number of studies of pharmacological interventions for PTSD, symptoms. substantial reduction in symptoms occured in the placebo treatment arms. Guidelines have suggested that although there is little difference between Range: 0–54 active therapy and placebo arms, drug therapy may still have a value in the 0–7: in the normal range (or in clinical remission) management of PTSD.6 ≥20: at least moderate severity1,9,10 Antidepressants: SSRIs and SNRIs Impact of the Event Scale-Revised (IES-R): Twenty-two-item self-report measure assessing current subjective distress for any In a systematic review, compared with placebo, paroxetine reduced specific life event. Each item rated on a scale of 0 (not at all), 1 (a little PTSD symptoms more (weighted mean difference [WMD] in Clinician- bit), 2 (moderately), 3 (quite a bit) or 4 (extremely) according to the Administered PTSD Scale [CAPS; see Box 2] –12.6, 95% CI –15.7 to –9.5, 2 past 7 days. RCTs, n=886, effect size Cohen’s d –0.49 [small to medium]) and depression symptoms more (Montgomery Åsberg Depression Rating Scale Range: 0–8811 [MADRS; see Box 2] WMD –5.7, 95% CI –7.1 to –4.3, 2 RCTs, n=886); 12.9% more people achieved remission (p=0.008, 2 RCTs, n=346, number- Montgomery Åsberg Depression Rating Scale (MADRS): Ten-item needed-to-treat [NNT]=8).1 clinician rated measure that assesses the severity of depression. The NICE 2005 analysis of sertraline (including data from six published Range: 0–60 trials and two unpublished industry trials) did not demonstrate clinically 0–6: normal/symptom absent important or statistically significant effects.21 In the later systematic review, compared with placebo, sertraline reduced PTSD symptoms (CAPS WMD 7–19: mild depression = –4.9, 95% CI –7.4 to –2.4, 7 RCTs, n 1,085, effect size Cohen’s d –0.25 [small 20–34: moderate depression to medium]) but did not significantly reduce depression symptoms (Hamilton Depression Rating Scale [HAMD; see Box 2] WMD –0.77, 95% CI >34: severe depression1,12 –2.1 to 0.55, 5 RCTs, n=1,010) or increase remission rates (24.3% vs. 19.6%, p=NS, 1 RCT, n=352).1 Posttraumatic Diagnostic Scale (PDS): Forty-nine-item self-report measure including the Posttraumatic Symptom Scale-Self Report (PSS-SR) Compared with placebo, fluoxetine reduced PTSD symptoms (CAPS WMD which has the following properties: –6.97, 95% CI –10.4 to –3.5, 4 RCTs, n=835, effect size Cohen’s d –0.31 [small to medium]) and depression symptoms (MADRS WMD –2.4, 95% CI –3.7 to 17 PTSD symptoms, each rated for severity from 0 (not at all or only one –1.1, 2 RCTs, n=712) but did not increase remission rates (13% vs. 10%, p=0.72, time) to 3 (5 or more times a week/almost always). 1 1 RCT, n=52). Range: 0–51 A second systematic review reported that paroxetine was more effective than >13 indicates likelihood of PTSD13–15 sertraline and fluoxetine in reducing symptom severity assessed using CAPS 22 score (p=0.001 and p=0.08, respectively). Short PTSD Rating Interview (SPRINT): Eight-item self-report measure In a systematic review, compared with placebo, venlafaxine ER reduced PTSD assessing the core symptoms of PTSD (intrusion, avoidance, numbing, symptoms (CAPS WMD –7.2, 95% CI –11.0 to –3.3, 2 RCTs, n=687) and arousal), somatic malaise, stress vulnerability, and role and social depression symptoms (HAMD WMD –2.08, 95% CI –3.12 to –1.04, 2 RCTs, n=687) functional impairment. Symptoms are rated on five point scales from and increased remission (risk difference 12%, 95% CI 5% to 19%, 2 RCTs, 0 (not at all) to 4 (very much). 1 n=687, NNT=9). Range: 0–32 The systematic review found that the evidence was insufficient to determine >6: symptomatic PTSD16,17 the efficacy of citalopram.1 The Committee on Safety of Medicines has reported that, as with other Structured Interview for PTSD (SIP or SI-PTSD): Seventeen items antidepressants, SSRIs and related antidepressants, especially paroxetine assessing PTSD symptoms and survival and behavioural guilt. For each and venlafaxine, are associated with withdrawal reactions, which may be item, the interviewer assigns a severity rating that reflects frequency severe. The most commonly experienced withdrawal reactions are and intensity. Items are scored on a scale from 0 (not at all) to 4 dizziness, numbness and tingling, gastrointestinal disturbances (extremely severe on a daily basis or produces so much distress that (particularly nausea and vomiting), headache, sweating, anxiety and patient cannot work or function socially). A symptom is counted as 18–20 sleep disturbances; these are less severe when the dose is tapered positive if it is rated ≥2 (moderate). gradually over a period of several weeks.23 dtb.bmj.com Vol 52 | No 4| April 2014 | DTB | 45 DTB | Management of adults with PTSD part II: drugs and other interventions Alpha blockers A systematic review found that internet-based cognitive behavioural therapy In a systematic review, compared with placebo, prazosin did not reduce PTSD (CBT) or internet-based trauma-focused writing sessions improved PTSD symptoms (CAPS WMD –8.9 95% CI –22.1 to 4.3, 2 RCTs, n=50).1 symptoms more than waiting list controls (large effect size: Cohen’s d 1.01, 95% CI 0.76 to 1.26, 5 RCTs, n=398).37 Second-generation (atypical) antipsychotics Combined pharmacological and In a systematic review, compared with placebo, risperidone had little or no psychological therapies clinically significant benefit for reduction of PTSD symptoms (CAPS WMD –4.60, 95% CI –9.0 to –0.2, 4 RCTs, n=419) and the effect on depression symptoms A systematic review included four studies that combined SSRIs with either 38 was not statistically significant (HAMD –3.7 vs.
Load more

Recommended publications
  • Meta-Analysis of the Efficacy of Treatments for Posttraumatic Stress Disorder Bradley V
    META-ANALYSIS Meta-Analysis of the Efficacy of Treatments for Posttraumatic Stress Disorder Bradley V. Watts, MD, MPH; Paula P. Schnurr, PhD; Lorna Mayo, MD, MPH; Yinong Young-Xu, PhD; William B. Weeks, MD, MBA; and Matthew J. Friedman, MD, PhD ABSTRACT treatments for posttraumatic stress disorder (PTSD) have Many 1 2 Objective: Posttraumatic stress disorder (PTSD) is been developed over the past 2 decades. , The treatments an important mental health issue in terms of the include a variety of psychotherapies, medications, and somatic and number of people affected and the morbidity and complementary therapies. The most commonly studied types of functional impairment associated with the disorder. psychotherapy are cognitive-behavioral therapies (CBTs), such as The purpose of this study was to examine the prolonged exposure, 3,4 cognitive processing therapy,5, 6 and cognitive efficacy of all treatments for PTSD. therapy,7,8 along with eye movement desensitization and reprocessing.9, 10 Data Sources: PubMed, MEDLINE, PILOTS, and Most of the research has focused on individual treatment, although PsycINFO databases were searched for randomized there have been some studies of group-based treatment as well. 11,12 The controlled clinical trials of any treatment for PTSD most commonly studied medications are antidepressants, particularly in adults published between January 1, 1980, and selective serotonin reuptake inhibitors (SSRIs). Atypical antipsychotic April 1,2012, and written in the English language. medications also have been studied relatively often, although to a far The following search terms were used: post-traumatic 1 3 141 5 lesser extent than antidepressants. , , stress disorders, posttraumatic stress disorder, PTSD, combat disorders, and stress disorders, post-traumatic.
    [Show full text]
  • (PTSD) Executive Summary
    Comparative Effectiveness Review Number 92 Effective Health Care Program Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) Executive Summary Background Effective Health Care Program Posttraumatic stress disorder (PTSD) is a mental disorder that may develop The Effective Health Care Program following exposure to a traumatic was initiated in 2005 to provide event. According to the 4th edition of valid evidence about the comparative the “Diagnostic and Statistical Manual effectiveness of different medical of Mental Disorders: DSM-IV-TR,”1 interventions. The object is to help the essential feature of PTSD is the consumers, health care providers, development of characteristic and others in making informed symptoms following exposure to a choices among treatment alternatives. traumatic stressor. PTSD is characterized Through its Comparative Effectiveness by three core symptom clusters: Reviews, the program supports (1) reexperiencing, (2) avoidance or systematic appraisals of existing numbing (or both), and (3) hyperarousal. scientific evidence regarding The full DSM-IV-TR criteria are listed treatments for high-priority health in Table A. conditions. It also promotes and generates new scientific evidence by Examples of traumatic events include identifying gaps in existing scientific military combat, motor vehicle evidence and supporting new research. collisions, violent personal assault, The program puts special emphasis being taken hostage, a terrorist attack, on translating findings into a variety torture, natural or human-caused of useful formats for different disasters, and, in some cases, being stakeholders, including consumers. diagnosed with a life-threatening illness.1 PTSD develops in up to a third of The full report and this summary are individuals who are exposed to extreme available at www.effectivehealthcare.
    [Show full text]
  • PTSD) Comparative Effectiveness Review Number 92
    Comparative Effectiveness Review Number 92 Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) Comparative Effectiveness Review Number 92 Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10056-I Prepared by: RTI International–University of North Carolina Evidence-based Practice Center Research Triangle Park, NC Investigators: Daniel E. Jonas, M.D., M.P.H. Karen Cusack, P h.D. Catherine A. Forneris, Ph.D., A.B.B.P. Tania M. Wilkins, M.S. Jeffrey Sonis, M.D., M.P.H. Jennifer Cook Middleton, Ph.D. Cynthia Feltner, M.D., M.P.H. Dane Meredith, M.P.H. Jamie Cavanaugh, Pharm.D. Kimberly A. Brownley, Ph.D. Kristine Rae Olmsted, M.S.P.H. Amy Greenblatt, B.A. Amy Weil, M.D. Bradley N. Gaynes, M.D., M.P.H. AHRQ Publication No. 13-EHC011-EF April 2013 Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) Structured Abstract Objectives. To assess efficacy, comparative effectiveness, and harms of ps ychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). Data sources. MEDLINE®, Cochrane Library, PILOTS, International Pharmaceutical Abstracts, CINAHL®, PsycINFO®, Web of Science, Emba se, U.S. Food and Drug Administration Web site, and reference lists of published literature (January 1980–May 2012). Review methods. Two investigators independently selected, extracted data from, and rated risk of bias of relevant trials. We conducted q uantitative analyses using rando m-effects models to estimate pooled effects.
    [Show full text]
  • Benzodiazepines Overview Benzodiazepines Are Prescription Medications That Have Been Around for Over 50 Years
    BENZODIAZEPINES OVERVIEW Benzodiazepines are prescription medications that have been around for over 50 years. They have commonly been prescribed to patients with a diagnosis of posttraumatic stress disorder (PTSD). Benzodiazepines may help in the short term and make you feel better quickly, but we now know that they do not improve the overall symptoms of PTSD and their helpful effects do BENZODIAZEPINES not last. and PTSD “ Some of you may be questioning If you have been taking these medications for yourself – if I reach out for help and get over a month, it is important for you to know treatment will it help me? I am a living that there are serious side effects associated If you have PTSD and take Valium, testimony that it helped me. But there with their continued use. The good news is that Xanax, Klonopin, Ativan or another there are benefits to stopping them. If you have anti -anxiety drug, here is what you are some caveats here and this is, first of tried to stop before, it is worth trying again need to know: all you need to want the help. Secondly, with your doctor’s supervision and support. •Why it is important to decrease your you need to embrace the help. Thirdly, In this brochure, you will learn how to decrease your use of benzodiazepines and about other use of benzodiazepines if medication is suggested be willing to treatments for PTSD that can help you get better. •How you can discontinue them with utilize the tools given to you. Be willing to your doctor’s help fully participate in your own recovery.” •Who should be particularly
    [Show full text]
  • The Comorbidity of PTSD and MDD: Implications for Clinical Practice and Future Research
    The Comorbidity of PTSD and MDD: Implications for Clinical Practice and Future Research Samantha Angelakis and Reginald D.V. Nixon School of Psychology, Flinders University, Adelaide, South Australia, Australia The high prevalence of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) comorbidity is well established, with comorbidity rates often be- tween 30 and 50%. However, despite the high prevalence of this comorbidity, very few researchers have explored specific treatments for individuals who present with comorbid PTSD and MDD. Further, there has not been explicit examination of the mechanisms through which MDD influences trauma-focused therapy. As individ- uals with comorbid PTSD and MDD often present with a more chronic course of impairment and in some instances, a more delayed response to treatment, the need for such research is imperative. It will be proposed that there is merit in targeting depression within the treatment of comorbid PTSD and MDD. Accordingly, in this article we review explanations for the high PTSD and MDD comorbid relationship and highlight variables likely to explain such comorbidity. Theoretical accounts for how depression impedes optimal recovery from PTSD and the associated empirical findings are illustrated. We consequently argue that there is a need to develop and test treatments that target both PTSD and MDD symptoms. Directions for future research are highlighted. Keywords: PTSD, MDD, comorbidity, treatment, emotional engagement It is well established that post-traumatic stress disorder (PTSD) often co-occurs with depression. Over a range of sample and trauma types it has been observed that 30– 50% of individuals with PTSD also meet the criteria for a diagnosis of depression (Creamer, Burgess, & McFarlane, 2001; Kessler, Berglund et al., 2005).
    [Show full text]
  • MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: a Review of the Literature Erin Solomon [email protected]
    Brigham Young University BYU ScholarsArchive All Student Publications 2018-05-01 MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: A Review of the Literature Erin Solomon [email protected] Follow this and additional works at: https://scholarsarchive.byu.edu/studentpub Part of the Mental Disorders Commons, and the Psychology Commons BYU ScholarsArchive Citation Solomon, Erin, "MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: A Review of the Literature" (2018). All Student Publications. 232. https://scholarsarchive.byu.edu/studentpub/232 This Class Project or Paper is brought to you for free and open access by BYU ScholarsArchive. It has been accepted for inclusion in All Student Publications by an authorized administrator of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. Running head: MDMA-ASSISTED PSYCHOTHERAPY MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: A Review of the Literature Effective psychotherapy may hinge on patients’ openness with therapists, willingness to confront and examine discomfort, and competence in processing emotion (Cloitre, Stovall- McClough, Miranda, & Chemtob, 2004; Doukas, D’Andrea, Doran, & Pole, 2014). For most patients, psychotherapy involves some psychological arousal, such as nervousness in front of a therapist or intense emotion during a discussion about sensitive issues (Doukas et al., 2014; Eftekhari et al., 2013). In some patients, however, arousal quickly rises above psychological control and triggers sympathetic nervous system arousal (Doukas et al., 2014). This kind of arousal is common among people with Posttraumatic Stress Disorder (PTSD) and often leads patients to avoid the triggering thought or emotion (Amoroso & Workman, 2016). The cycle of accessing emotionally charged content, experiencing arousal, and promptly practicing avoidance may render psychotherapy impossible and frustrate patients (Amoroso & Workman, 2016).
    [Show full text]
  • Sertraline Increased the Response Rate and Improved Symptoms in Post-Traumatic Stress Disorder
    Evid Based Mental Health: first published as 10.1136/ebmh.3.4.109 on 1 November 2000. Downloaded from Sertraline increased the response rate and improved symptoms in post-traumatic stress disorder 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;283:1837–44. Source of funding: QUESTION: In patients with post-traumatic stress disorder (PTSD), is sertraline Pfizer Inc. effective for improving symptomatic outcomes? For correspondence: Dr K Brady, Department of Psychiatry, Medical University of South Design Conclusion Carolina, 67 President Randomised (unclear allocation concealment*), blinded In patients with post-traumatic stress disorder, sertraline Street, PO Box (unclear)*, placebo controlled trial with 12 weeks of fol- increased the response rate and improved symptoms. 250861, Charleston, SC 29425, USA. Fax low up. *See glossary. +1 843 792 7353. Setting Sertraline v placebo for post-traumatic stress disorder† Outpatient clinics in 8 academic medical centres and 6 clinical research centres in the US. Outcomes at 12 weeks Sertraline Placebo RBI (95% CI) NNT (CI) Response rate 53% 32% 64% (16 to 135) 5 (3 to 17) Patients Mean change from 187 patients who were ≥ 18 years of age (mean age 40 baseline y, 73% women); had PTSD according to DSM-III-R cri- Difference in mean change from teria for at least 6 months with a severity score ≥ 50 on Sertraline Placebo baseline (CI) the Clinician Administered PTSD Scale, Part 2 (CAPS- CAPS-2 total score −33.0 −23.2 9.8 (1.8 to 17.8) 2); and had not taken psychotropic medication in the IES total score −16.2 −12.1 4.1 (−0.4to8.6)‡ previous 2 weeks.
    [Show full text]
  • Clinician's Guide to Medications for PTSD Matt Jeffreys, M.D
    Clinician's Guide to Medications for PTSD Matt Jeffreys, M.D. www.ptsd.va.gov Overview While each case of PTSD has unique biological, psychological, and social determinants with differing treatment implications, there are empirically supported treatments that can reduce or alleviate symptoms. Medications can be used to ameliorate the biological basis for PTSD symptoms along with co-occurring psychiatric diagnoses, and indirectly may benefit psychological and social symptoms as well. Studies suggest that cognitive behavioral therapies (CBT) such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) have greater effects on relieving PTSD symptoms than medications (2), but there have been few head-to-head comparisons, and there remain many unanswered questions regarding the role of pharmacotherapy. Clinicians must consider the level of evidence available supporting the specific medication interventions being considered. Randomized clinical trials (RCTs) which are placebo-controlled and double blinded are the gold standard for guiding pharmacotherapy decision making. More powerful conclusions can be drawn from systematic reviews and meta-analyses that look at all RCTs that have been done with a specific medication. Less strongly supported evidence includes open trials and case reports. It is vital to question the level of evidence supporting the medications being prescribed for PTSD when making treatment recommendations, because there are a variety of influences on prescribing, including marketing, patient preferences, and clinical custom, all of which can be inconsistent with the current scientific evidence. Evidence for PTSD pharmacology is strongest for specific selective serotonin reuptake inhibitors (SSRIs) - sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) -- and a particular serotonin norepinephrine reuptake inhibitor (SNRI) - venlafaxine (Effexor) (1).
    [Show full text]
  • Randomized, Double-Blind Comparison of Sertraline and Placebo for Posttraumatic Stress Disorder in a Department of Veterans Affairs Setting
    Randomized, Double-Blind Comparison of Sertraline and Placebo for Posttraumatic Stress Disorder in a Department of Veterans Affairs Setting Matthew J. Friedman, M.D., Ph.D.; Charles R. Marmar, M.D.; Dewleen G. Baker, M.D.; Carolyn R. Sikes, Ph.D.; and Gail M. Farfel, Ph.D. Received March 17, 2006; acceptedAug. 23, 2006. From the Departmentof Veterans Affairs, National Centerfor Posttraumatic Stress Disorder; White River Junction, Vt., and the Departments of Psychiatryand Pharmacology& Toxicology, Dartmouth Medical School, Hanover; N.H. (Dr.Friedman); the Department of Psychiatry, University of California,and Department of Veterans Affairs Medical Center; San Francisco,Calif. (Dr. Marmar); the Department of Psychiatry,University of California,Veterans Affairs San Diego HealthcareSystem, San Diego, Calif.(Dr Baker); and Pfizer Inc., New York, N.Y (Drs.Sikes and Objective: To evaluate the efficacy of sertra Fafel).Dr. Farfel is now with Novartis, East Hanover,NJ. line in the treatment of posttraumatic stress disor Supported by fundingfrom Pfizer Inc. Acknowledgments are listed at the end of this article. der (PTSD) in a Veterans Affairs (VA) clinic set Statements of the authors do not reflect official policy or opinions ting involving patients with predominantly of the U.S. Department of Veterans Affairs. combat-related PTSD. Dr.Baker is a stock shareholderof Pfizer and was a site investigator Method: 169 outpatient subjects with a on the project that produced datafor this manuscript. Dr.Sikes is an DSM-III-R diagnosis of PTSD and who scored 50 employee and Dr.Farfel is a former employee of Pfizer Inc. Drs. or higher on Part 2 of the Clinician-Administered Friedman and Marmarreport no additionalfinancial or other relationshipsrelevant to the subject of this article.
    [Show full text]
  • MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder
    MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder A Revised Teaching Manual Draft (Revised 11/24/08) June M. Ruse, Psy.D. Lisa Jerome, Ph.D. Michael C. Mithoefer, M.D. Rick Doblin, Ph.D. Elizabeth Gibson, M.S. 1 TABLE OF CONTENTS 1.0 Introduction 1.1 Background 1.2 Goals of this Manual 2.0 Conditions for the Use of MDMA-Assisted Psychotherapy 2.1 Prerequisites and Contraindications 2.2 Assessment Protocol – Baseline Measures 3.0 Phase I: Preparation for MDMA-Assisted Psychotherapy Sessions 3.1 Establishing a Therapeutic Alliance, Gathering Information, Participant Orientation 3.2 Creating a Safe Psychological and Physical Space 3.3 Therapist Foundation 4.0 Phase II: MDMA-Assisted Psychotherapy Sessions 4.1 Initiating Therapy 4.2 MDMA-Assisted Therapy Sessions 4.3 Role of the Therapist During MDMA-Assisted Therapy Sessions (Phase II) 5.0 Phase III: Follow-Up and Integration Sessions 5.1 Post MDMA-session 5.2 Follow-Up and Integration Sessions 5.3 Therapists’ Role During Follow-Up and Integration Sessions (Phase III) References Appendix A: Comparison of Therapeutic Approaches for Treating PTSD Appendix B: Focused Bodywork 2 1.0 INTRODUCTION 1.1 Background The Multidisciplinary Association for Psychedelic Studies (MAPS) is sponsoring a series of Phase II clinical trials to explore the potential risks and benefits of MDMA-assisted psychotherapy in treatment-resistant posttraumatic stress disorder (PTSD) participants. This manual provides researchers with a method of MDMA-assisted psychotherapy to be used in conducting these trials. 3, 4- methylenedioxy – N – methylamphetamine (MDMA) produces an experience that has been described in terms of “inhibiting the subjective fear response to an emotional threat” (Greer & Tolbert, 1998, p.
    [Show full text]
  • PTSD Nightmares: Prazosin and Atypical Antipsychotics
    Savvy Psychopharmacology PTSD nightmares: Prazosin and atypical antipsychotics Rebecca L. Graham, PharmD, Susan G. Leckband, RPh, BCPP, and Rene A. Endow-Eyer, PharmD, BCPP r. S, a 45-year-old veteran, was diag- PTSD occurs in approximately 19% of nosed with posttraumatic stress disor- Vietnam war combat veterans1 and 14% der (PTSD) 18 years ago after a tour of of service members returning from Iraq M 2 duty in the Persian Gulf. He had combat-related and Afghanistan. PTSD symptoms are flashbacks triggered by the smell of gasoline or classified into clusters: intrusive/re- smoke from a fire, was easily startled, and began experiencing; avoidant/numbing; and to isolate himself socially. However, his symp- hyperarousal.3 Nightmares are part of the Vicki L. Ellingrod, toms improved when he started volunteering at intrusive/re-experiencing cluster, which is PharmD, BCPP, FCCP his local Veterans Affairs Medical Center. After he Criterion B in DSM-IV-TR. See this article Series Editor lost his job 3 years ago, Mr. S started experiencing at CurrentPsychiatry.com for a descrip- flashbacks. He was irritable, easily startled, and tion of DSM-IV-TR PTSD criteria. Among avoided things that reminded him of his time in PTSD patients, 50% to 70% report PTSD- the Persian Gulf. His psychiatrist prescribed ser- associated nightmares.4 Despite adequate traline, titrated to 200 mg/d. The drug reduced treatment targeted to improve PTSD’s core the severity of his avoidance and hyperarousal symptoms, symptoms such as sleep distur- symptoms and improved his mood. bances or nightmares often persist. During a clinic visit, Mr.
    [Show full text]
  • MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder
    University of Connecticut OpenCommons@UConn Doctoral Dissertations University of Connecticut Graduate School 6-22-2020 MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: Examining Ethnoracial Differences in Efficacy and Safety, and a Mixed-Methods Case Study of a Participant of Color Terence Ching University of Connecticut, [email protected] Follow this and additional works at: https://opencommons.uconn.edu/dissertations Recommended Citation Ching, Terence, "MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: Examining Ethnoracial Differences in Efficacy and Safety, and a Mixed-Methods Case Study of a Participant of Color" (2020). Doctoral Dissertations. 2560. https://opencommons.uconn.edu/dissertations/2560 Running Head: MDMA-ASSISTED PSYCHOTHERAPY FOR PTSD MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: Examining Ethnoracial Differences in Efficacy and Safety, and a Mixed-Methods Case Study of a Participant of Color Terence H. W. Ching, Ph.D. University of Connecticut, 2021 MDMA-assisted psychotherapy was shown in previous clinical trials to be efficacious and safe for alleviating treatment-resistant posttraumatic stress disorder (PTSD). However, due to low ethnoracial diversity, the question remains as to whether ethnoracial minority participants would benefit similarly. Thus, in Study 1, ethnoracial differences in PTSD symptoms, secondary outcomes, and suicidality were examined for a multisite, open-label trial of MDMA-assisted psychotherapy. A total of 11 ethnoracial minority and 26 non-Hispanic White participants formed the modified intent-to-treat (ITT) set. General and generalized linear model analyses were used to test group differences. Correlational analyses were conducted to test relationships between changes in certain secondary outcomes/putative mechanisms of action and PTSD symptoms for the entire sample.
    [Show full text]