Pharmacotherapy in Post-Traumatic Stress Disorders. The experience in a refugee population

Author/s Emilio Vercillo, Giancarlo Santone, Rossella Carnevali
Publishing Year 2019 Issue 2018/43
Language Italian Pages 14 P. 26-39 File size 103 KB
DOI 10.3280/QPC2018-043002
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The psychopharmacotherapy of PTSD and post-traumatic conditions couldn’t be categorially outlined, nor it could be a point-to-point symptomatic aimed therapy. The authors suggest a strategic vision of pharmaceutical tools, inside the global structure of the treatment. In this paper the literature on pharmacotherapy of PTSD, is reviewed and commented, according the different categories of drugs. Lastly, they propose some practical lines of pharmacotherapic intervention, based on the clinical experience on a refugee population.

Keywords: Pharmachotherapy, PTSD, dissociation.

  1. Committee on Treatment of Posttraumatic Stress Disorder (Institute of Medicine) (2007). Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence. Washington, DC: The National Academies Press [cit. in Murray B. Stein et al., 2018 (6)].
  2. Davidson J., Baldwin D., Stein D.J., Kuper E., Benattia I., Ahmed S., Pedersen R., Musgnung J. (2006). Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Arch. Gen. Psychiatry, 63(10): 1158.
  3. Feder A., Parides M.K., Murrough J.W., Perez A.M., Morgan J.E., Saxena S., Kirkwood K., Aan Het Rot M., Lapidus K.A., Wan L.B., Iosifescu D., Charney D.S. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 71(6): 681.
  4. Stein M.B., Roy-Byrne P.P., Hermann R. (2018). Pharmacotherapy for posttraumatic stress disorder in adults, UpToDate.
  5. Taylor F., Raskind M.A. (2002). The alpha1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J. Clin. Psychopharmacol., 22(1): 82 PMID: 11799347.
  6. Vercillo E. (1999). Farmacoterapia e etnicità. PSYCHOMEDIA. --
  7. Veterans Affairs Cooperative Study No. 504 Group (2011). Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: a randomized trial. JAMA, 306(5): 493.
  8. Stein M.B., Kline N.A., Matloff J.L. (2002). Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am. J. Psychiatry, 159(10): 1777-9.
  9. Stein D.J., Ipser J.C., Seedat S. (2006). Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev., 25(1).
  10. Steenen S.A., van Wijk A.J., van der Heijden G.J., van Westrhenen R., de Lange J., de Jongh A. (2016). Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis. J. Psychopharmacol., 30(2): 128-39. DOI: 10.1177/026988111561223
  11. Standards of Practice Committee, American Academy of Sleep Medicine (2010).Best practice guide for the treatment of nightmare disorder in adults. J. Clin. Sleep Med., 6(4): 389. DOI: 10.5664/JCSM.133
  12. Singh B., Hughes A.J., Mehta G. et al. (2016). Efficacy of Prazosin in Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis, Primary Care Companion for CNS Disorders, 18(4).
  13. Siegel D.J. (1999, 2 ed. 2015). The Developing Mind, Second Edition: How Relationships and the Brain Interact. New York: The Guilford Press.
  14. Roy-Byrne P. (2018). Prazosin Is Ineffective for Chronic PTSDin Military Veterans, reviewing Raskind M.A. et al. N. Engl. J. Med., 8. -
  15. Rothbaum B.O., Price M., Jovanovic T., Norrholm S.D., Gerardi M., Dunlop B., Davis M., Bradley B., Duncan E.J., Rizzo A., Ressler K.J. (2014). A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans. Am. J. Psychiatry, 171(6): 640.
  16. Ressler Kerry J. (2018). Alpha-Adrenergic Receptors in PTSD – Failure or Time for Precision Medicine? N. Engl. J. Med., 378: 575-576.
  17. Ravindran L.N., Stein M.B. (2009). Pharmacotherapy of PTSD: premises, principles, and priorities. Brain Res., 1293: 24.
  18. Raskind M.A., Peterson K., Williams T., Hoff D.J., Hart K., Holmes H., Homas D., Hill J., Daniels C., Calohan J., Millard S.P., Rohde K., O’Connell J., Pritzl D., Feiszli K., Petrie E.C., Gross C., Mayer C.L., Freed M.C., Engel C., Peskind E.R. (2013). A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am. J. Psychiatry, 170(9): 1003.
  19. Raskind M.A., Peskind E.R., Chow B. et al. (2018). Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. N. Engl. J. Med., 378: 507-517.
  20. Raskind M.A., Millard S.P. et al. (2016). Higher Pretreatment Blood Pressure Is Associated With Greater Posttraumatic Stress Disorder Symptom Reduction in Soldiers Treated With Prazosin. Biol. Psychiatry, 15, 80(10): 736-742.
  21. Porges S. (2011). The polyvagal theory: Neurophysiologial foundations of emotions, attachment, communication, and self-regulation. New York: W.W. Norton & Company.
  22. Porges S. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42: 123-146. 1016/S0167-8760(01)00162-3
  23. Nadorff M.R., Lambdin K.K., Germain A. (2014): Pharmacological and non-pharmacological treatments for nightmare disorder. Int. Rev. Psychiatry, 26(2): 225. DOI: 10.3109/09540261.2014.88898
  24. Mohamed S., Rosenheck R.A. (2008). Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection. J. Clin. Psychiatry, 69(6): 959.
  25. Lin K.M., Smith M.W. (2001). Psychopharmacotherapy in the context of culture and ethnicity. In: Ruiz P. (ed.), Review. Ethnicity and Psychopharmacology. Washington, DC: American Psychiatric Association.
  26. Lillie E.O., Pata B., Diamant J., Issell B., Topol E.J., Schork N.J. (2011). The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized Medicine, 8(2): 161-173.
  27. Kierlin L., Littner M.R. (2011). Parasomnias and antidepressant therapy: a review of the literature. Front Psychiatry, 2: 71.
  28. Khachatryan D., Groll D., Booij L., Sepehry A.A., Schütz C.G. (2016). Prazosin for treating sleep disturbances in adults with posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. Gen. Hosp. Psychiatry, 39: 46.
  29. Hendrickson R., Millard S., Shofer J., Peskind E., Raskind M. (2017). The Effect of Prazosin on Individual PTSD Symptoms and on the Covariance of Symptoms Over Time: Evidence for Pathophysiologically-Related Clustering. ACNP 56th Annual Meeting: Poster Session Neuropsychopharmacology, 42: S111-S293.
  30. Hendrickson R.C., Raskind Murray A. (2016). Noradrenergic dysregulation in the pathophysiology of PTSD. Experimental Neurology, vol. 284, Part B: 181-195.
  31. George K.C., Kebejian L., Ruth L.J., Miller C.W., Himelhoch S. (2016). Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder. J. Trauma Dissociation, 17(4): 494. DOI: 10.1080/15299732.2016.114115

Emilio Vercillo, Giancarlo Santone, Rossella Carnevali, Strategie farmaco terapeutiche nei disturbi post-traumatici. L’esperienza su una popolazione di rifugiati in "QUADERNI DI PSICOTERAPIA COGNITIVA" 43/2018, pp 26-39, DOI: 10.3280/QPC2018-043002