Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-19T05:27:55.944Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment-Resistant Posttraumatic Stress Disorder: Strategies for Intervention

Published online by Cambridge University Press:  07 November 2014

Mark B. Hamner ,
Sophie Robert  and
B. Christopher Frueh
Get access Rights & Permissions [Opens in a new window]

Abstract

The mainstay of treatment for chronic posttraumatic stress disorder (PTSD) is a combination of psychotherapy and medication treatments. The first-line medications for PTSD are antidepressants, with two selective serotonin reuptake inhibitors (sertraline and paroxetine) currently Food and Drug Administration-indicated for PTSD. However, many patients do not have an adequate response to antidepressants, therefore, combinations with other antidepressants or with other classes of psychotropic medication are often utilized to enhance the therapeutic response. Other agents that have been used include mood stabilizers, antiadrenergics, anxiolytics, and atypical antipsychotics. The heterogeneity of symptom clusters in PTSD as well as the complex psychiatric comorbidities (eg, with depression or substance abuse) further support the notion that combinations of medications may be needed. To date, there is a paucity of data to support specific strategies for augmenting antidepressants in PTSD. This review will address representative existing studies and discuss several potential pharmacologic strategies for patients suffering from treatment refractory PTSD.

Type
Review Articles
Information
CNS Spectrums , Volume 9 , Issue 10 , October 2004 , pp. 740 - 752
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–1060.Google ScholarPubMed
3.Kulka, RA, Schlenger, WE, Fairbank, JA, et al.Trauma and the Vietnam war Generation. Report of Findings from the National Vietnam Veterans Readjustment Study. New York, NY: Brunner/Mazel; 1990.Google Scholar
4.Kosten, TR, Frank, JB, Dan, E, McDougle, CJ, Giller, EL Jr.Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. J Nerv Ment Dis. 1991;179:366–370.CrossRefGoogle ScholarPubMed
5.Davidson, J, Kudler, H, Smith, R, Mahorney, SL, et al.Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry. 1990;47:259–256.CrossRefGoogle ScholarPubMed
6.Brady, K, Pearlstein, T, Asnis, GM, et al.Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283:1837–1844.CrossRefGoogle ScholarPubMed
7.Davidson, JR, Rothbaum, BO, van der Kolk, BA, Sikes, CR, Farfel, GM. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58:485–492.CrossRefGoogle ScholarPubMed
8.Marshall, RD, Beebe, KL, Oldham, M, Zaninelli, R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed dose, placebo–controlled study. Am J Psychiatry. 2001;158:1982–1988.CrossRefGoogle ScholarPubMed
9.Tucker, P, Zaninelli, R, Yehuda, R, Ruggiero, L, Dillingham, K, Pitts, CD. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry. 2001;62:860–868.CrossRefGoogle ScholarPubMed
10.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;122:386–389.CrossRefGoogle ScholarPubMed
11.Connor, KM, Sutherland, SM, Tupler, LA, Malik, ML, Davidson, JR. Fluoxetine in post-traumatic stress disorder. Randomized, double-blind study. Br J Psychiatry. 1999;175:17–22.CrossRefGoogle Scholar
12.Martenyi, F, Brown, EB, Zhang, H, Prakash, A, Koke, SC. Fluoxetine versus placebo in posttraumatic stress disorder. J Clin Psychiatry. 2002;63:199–206.Google ScholarPubMed
13.Martenyi, F, Brown, EB, Zhang, H, Koke, SC, Prakash, A. Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder. Br J Psychiatry. 2002;181:315–320.CrossRefGoogle ScholarPubMed
14.Tucker, P, Potter-Kimball, R, Wyatt, DB, et al.Can physiologic assessment and side effects tease out differences in PTSD trials? A double-blind comparison of citalopram, sertraline, and placebo. Psychopharmacol Bull. 2003;37:135–149.Google ScholarPubMed
15.Davis, LL, Jewell, ME, Ambrose, S, et al.A placebo-controlled study of nefazodone for the treatment of chronic posttraumatic stress disorder: a preliminary study. J Clin Psychopharmacol. 2004;24:291–297CrossRefGoogle ScholarPubMed
16.Davidson, J, Lipschitz, A, Musgnung, JJ. Venlafaxine XR and sertraline in posttraumatic stress disorder: a placebo-controlled study. Poster presented at: annual meeting of the Anxiety Disorders Association of America. March 27-30, 2003; Toronto, Canada.Google Scholar
17.Davidson, JRT, Weisler, RH, Butterfield, MI, et al.Mirtazapine vs placebo in posttraumatic stress disorder: a pilot trial. Biol Psychiatry. 2003;53:188–191.CrossRefGoogle ScholarPubMed
18.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;122:386–389.CrossRefGoogle ScholarPubMed
19.Hertzberg, MA, Feldman, ME, Beckman, JC, Kudler, HS, Davidson, JR. Lack of efficacy for fluoxetine in PTSD: a placebo-controlled trial in combat veterans. Ann Clin Psychiatry. 2000;12:101–105.CrossRefGoogle ScholarPubMed
20.van der Kolk, BA, Dreyfuss, D, Micheals, M, et al.Fluoxetine in posttraumatic stress disorder. J Clin Psychiatry. 1994;55:517–522.Google ScholarPubMed
21.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;22:190–195.CrossRefGoogle ScholarPubMed
22.Ballenger, JC, Davidson, JR, 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):60–66.Google Scholar
23.The expert consensus guideline series. Treatment of Posttraumatic Stress Disorder. The Expert Consensus Panels for PTSD. J Clin Psychiatry. 1999;60(suppl 16):3–76.Google Scholar
24.Blake, D, Weather, F, Nagy, L, et al.A clinician rating scale for assessing current and lifetime PTSD: the CAPS 1. Behav Ther. 1990;13:187–188.Google Scholar
25.Hamilton, MA. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRefGoogle ScholarPubMed
26.Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261–276.CrossRefGoogle ScholarPubMed
27.Friedman, MJ, Dube, EM, Beebe, KL, et al.Paroxetine effectively treats post-traumatic stress disorder (PTSD) in males. Eur Neuropsychopharmacol. 2002;12(suppl 3):S353.CrossRefGoogle Scholar
28.McRae, AL, Brady, KT, Mellman, TA, et al.Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depress Anxiety. 2004;19:190–196.CrossRefGoogle ScholarPubMed
29.Smajkic, A, Weine, S, Djuric-Bijedic, Z, et al.Sertraline, paroxetine, and venlafaxine in refugee posttraumatic stress disorder with depression symptoms. J Trauma Stress. 2001;14:445–452.CrossRefGoogle ScholarPubMed
30.Chung, MY, Jun, YJ, Kim, SS, et al.Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder. Eur Neuropsychopharmacol. 2003;13 (suppl 4):S433.CrossRefGoogle Scholar
31.Hamner, MB, Frueh, BC. Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with posttraumatic stress disorder. Int Clin Psychopharmacol. 1998;13:233–234.CrossRefGoogle Scholar
32.Zisook, S, Chentsova-Dutton, YE, Smith-Vaniz, A, et al.Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry. 2000;61:203–208.CrossRefGoogle ScholarPubMed
33.Foa, EB, Keane, TM, Friedman, MJ. Guidelines for treatment of PTSD: introduction. J Trauma Stress. 2000;13:539–555.CrossRefGoogle Scholar
34.Foa, EG, Keane, TM, Friedman, MJ. Effective Treatments for PTSD. New York, NY: Guilford Press; 2000.Google Scholar
35.Blanchard, EB, Hickling, EJ, Devineni, T, et al.A controlled evaluation of cognitive behavioral therapy for posttraumatic stress in motor vehicle accident survivors. Behav Res Ther. 2003;41:79–96.CrossRefGoogle ScholarPubMed
36.Foa, EB. Psychosocial treatment of posttraumatic stress disorder. J Clin Psychiatry 2000;61(suppl 5):49–51.Google ScholarPubMed
37.Frueh, BC, Turner, SM, Beidel, DC, Mirabella, RF, Jones, WJ. Trauma management therapy: a preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD. Behav Res Ther. 1996;34:533–543.CrossRefGoogle ScholarPubMed
38.Keane, TM. The role of exposure therapy in the psychological treatment of PTSD. NCP Clinical Quarterly. 1995;5:1–6.Google Scholar
39.Frueh, BC, Buckley, TC, Cusack, KJ, et al.Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model. J Psychiatr Pract. 2004;10:26–38.CrossRefGoogle ScholarPubMed
40.Foa, EB, Dancu, CV, Hembree, EA, Jaycox, LH, Meadows, EA, Street, GP. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol. 1999;67:194–200.CrossRefGoogle ScholarPubMed
41.Lubin, H, Loris, M, Burt, J, et al.Efficacy of psychoeducational group therapy in reducing symptoms of posttraumatic stress disorder among multiply traumatized women. Am J Psychiatry. 1998;155:1172–1177.CrossRefGoogle ScholarPubMed
42.Glynn, SM, Eth, S, Randolph, ET, et al.A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. J Consult Clin Psychol. 1999;67:243–251.CrossRefGoogle ScholarPubMed
43.Pantalon, MV, Motta, RW. Effectiveness of anxiety management training in the treatment of posttraumatic stress disorder: a preliminary report. J Behav Ther Exp Psychiatry. 1998;29:21–29.CrossRefGoogle ScholarPubMed
44.Triffleman, E, Carroll, K, Kellogg, S. Substance dependence posttraumatic stress disorder therapy. An integrated cognitive-behavioral approach. J Subst Abuse Treat. 1999;17:3–14.Google ScholarPubMed
45.Humphreys, L, Westerink, J, Giarratano, L, Brooks, R. An intensive treatment program for chronic posttraumatic stress disorder: 2-year outcome data. Aust N Z J Psychiatry. 1999;33:848–854.CrossRefGoogle ScholarPubMed
46.Foa, EB, Rotherbaum, BO, Furr, JM. Augmenting exposure therapy with other CBT procedures. Psychiatric Annals. 2003;33:47–53.CrossRefGoogle Scholar
47.Otto, MW, Hinton, D, Korbly, NB, et al.Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther. 2003;41:1271–1276.CrossRefGoogle ScholarPubMed
48.Frommberger, U, Stieglitz, RD, Nyberg, E, et al.Comparison between paroxetine and behavior therapy in patients with posttraumatic stress disorder (PTSD): a pilot study. Int J Psychiatry Clin Practice. 2004;8:19–23.CrossRefGoogle ScholarPubMed
49.Cahill, SP. Augmentation of sertraline with prolonged exposure (PE) in the treatment of PTSD: does PE protect against relapse when medication is discontinued? Poster presented at: annual meeting of the Anxiety Disorders Association of America. April 27-30, 2003; Toronto, Canada.Google Scholar
50.Bond, GR, Drake, RE, Becker, DR, et al.Effectiveness of psychiatric rehabilitation approaches for employment of people with severe mental illness. Journal of Disability Policy Studies. 1999;10:18–52.CrossRefGoogle Scholar
51.Drake, RE, McHugo, GJ, Bebout, RR, et al.A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Arch Gen Psychiatry. 1999;56:627–633.CrossRefGoogle ScholarPubMed
52.Fontana, A, Rosenheck, RA. Effects of compensation-seeking on treatment outcomes among veterans with posttraumatic stress disorder. J Nerv Ment Dis. 1998;186:223–230.Google ScholarPubMed
53.Frueh, BC, Elhai, JD, Gold, PB, et al.Disability compensation seeking among combat veterans evaluated for posttraumatic stress disorder. Psychiatr Serv. 2003;54:84–91.CrossRefGoogle ScholarPubMed
54.Londborg, PD, Hegel, MT, Goldstein, S, et al.Sertraline treatment of posttraumatic stress disorder: results of 24 weks of open-label continuation treatment. J Clin Psychiatry. 2001;62:325–331.Google Scholar
55.Martenyi, F, Brown, EB, Zhang, H, Koke, SC, Prakash, A. Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder. Br J Psychiatry. 2002;181:315–320.CrossRefGoogle ScholarPubMed
56.Davidson, J, Pearlstein, T, Londborg, P, et al.Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week doubleblind, placebo-controlled study. Am J Psychiatry. 2001;158:1974–1981.CrossRefGoogle ScholarPubMed
57.Rapaport, MH, Endicott, J, Clary, CM. Posttraumatic stress disorder and quality of life: results across 64 weeks of sertraline treatment. J Clin Psychiatry. 2002;63:59–65.CrossRefGoogle ScholarPubMed
58.Clayton, AH, Pradko, JF, Croft, HA, et al.Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63:357–366.CrossRefGoogle ScholarPubMed
59.Ferguson, JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clin Psychiatry. 2001;3:22–27.Google ScholarPubMed
60.Raskind, MA, Peskind, ER, Kanter, ED, et al.Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160:371–373.CrossRefGoogle ScholarPubMed
61.Southwick, SM, Bremner, JD, Rasmusson, A, Morgan, CA 3rd, Arnsten, A, Charney, DS. Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry. 1999;46:1192–1204.CrossRefGoogle ScholarPubMed
62.Warner, MD, Dorn, MR, Peabody, CA. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry. 2001;34:128–131.CrossRefGoogle ScholarPubMed
63.Canive, JM, Clark, RD, Calais, LA, et al.Bupropion treatment in veterans with posttraumatic stress disorder: an open study. J Clin Psychopharmacol. 1998;18:379–383.CrossRefGoogle ScholarPubMed
64.Clayton, AH, Warnock, JK, Kornstein, SG, et al.A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 2004;65:62–67.CrossRefGoogle ScholarPubMed
65.Lewis, JD. Mirtazapine for PTSD nightmares. Am J Psychiatry. 2002;159:1948–1949.CrossRefGoogle ScholarPubMed
66.Heit, S, Nemeroff, CB. Lithium augmentation of antidepressants in treatment-refractory depression. J Clin Psychiatry. 1998;59(suppl 6):28–33.Google ScholarPubMed
67.Kitchner, I, Greenstein, R. Low dose lithium carbonate in the treatment of post traumatic stress disorder: brief communication. Mil Med. 1985;150:378–381.CrossRefGoogle ScholarPubMed
68.Forster, PL, Schoenfeld, FB, Marmar, CR, Lang, AJ. Lithium for irritability in PTSD. J Trauma Stress. 1995;8:143–149.Google Scholar
69.Post, RM, Weiss, N, Smith, MA. Sensitization and kindling: implications for the evolving neural substrates of posttraumatic stress disorder. In: Friedman, MJ, Charney, DS, Deutch, AY, eds. Neurobiological and Clinical Consequences of Stress: From Normal Adaptation to PTSD. Philadelphia, Pa: Lippincott-Raven; 1995:203–224.Google Scholar
70.Goddard, GV, McIntyre, DC, Leech, CK. A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol. 1969;25:295–330.Google ScholarPubMed
71.Fesler, FA. Valproate in combat-related posttraumatic stress disorder. J Clin Psychiatry. 1991;52(suppl):361–364.Google ScholarPubMed
72.Clark, RD, Canive, JM, Calais, LA, et al.Divalproex in posttraumatic stress disorder: an open-label clinical trial. J Trauma Stress. 1999;12:395–401.CrossRefGoogle ScholarPubMed
73.Petty, F, Davis, LL, Nugent, AL, et al.Valproate therapy for chronic, combat-induced posttraumatic stress disorder. J Clin Psychopharmacol. 2002;22:100–101.CrossRefGoogle ScholarPubMed
74.Otte, C, Wiedemann, K, Yassouridis, A, Kellner, M. Valproate monotherapy in the treatment of civilian with non-combat-related posttraumatic stress disorder: an open-label study. J Clin Psychopharmacol. 2004;24:106–108.CrossRefGoogle ScholarPubMed
75.Lipper, S, Davidson, JR, Grady, TA, et al.Preliminary study of carbamazepine in post-traumatic stress disorder. Psychosomatics. 1986;27:849–854.CrossRefGoogle ScholarPubMed
76.Wolf, ME, Alavi, A, Mosnaim, AD. Posttraumatic stress disorder in Vietnam veterans: clinical and EEG findings, possible therapeutic effects of carbamazepine. Biol Psyhchiatry 1988;23:642–644.CrossRefGoogle ScholarPubMed
77.Berlant, JL. Topiramate in posttraumatic stress disorder: preliminary clinical observations. J Clin Psychiatry. 2001;62(suppl 17):60–63.Google ScholarPubMed
78.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;63:15–20.CrossRefGoogle ScholarPubMed
79.Taylor, FB. Tiagabine for posttraumatic stress disorder: a case series of 7 women. J Clin Psychiatry. 2003;64:1421–1425.CrossRefGoogle ScholarPubMed
80.Hamner, MB, Brodrick, PS, Labbate, LA. Gabapentin in PTSD: a retrospective clinical series of adjunctive therapy. Ann Clin Psychiatry. 2001;3:141–146.CrossRefGoogle Scholar
81.Hollander, E, Tracy, KA, Swann, AC, et al.Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology. 2003;28:1186–1197.CrossRefGoogle ScholarPubMed
82.Hamner, MB, Faldowski, RA, Robert, S, et al. A preliminary controlled trial of divalproex in PTSD. Poster presented at: annual meeting of the New Clinical Drug Evaluation Unit. June 1-4, 2004; Phoenix, AZ.Google Scholar
83.Hertzberg, MA, Butterfield, MI, Feldman, ME, et al.A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biol Psychiatry. 1999;45:1226–1229.CrossRefGoogle ScholarPubMed
84.Braun, P, Greenberg, D, Dasberg, H, Lerer, B. Core symptoms of PTSD unimproved by alprazolam treatment. J Clin Psychiatry. 1990;51:236–238.Google ScholarPubMed
85.Bremner, JD, Innis, RB, Southwick, SM, Staib, L, Zoghbi, S, Charney, DS. Decreased benzodiazepine receptor binding in prefrontal cortex in combat-related posstraumatic stress disorder. Am J Psychiatry. 2000;157:1120–1126.CrossRefGoogle Scholar
86.Mellman, TA, Byers, PM, Augenstein, JS. Pilot evaluation of hypnotic medication during acute traumatic stress response. J Trauma Stress. 1998;11:563–569.CrossRefGoogle ScholarPubMed
87.Gelpin, E, Bonne, O, Peri, T, et al.Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996;57:390–394.Google ScholarPubMed
88.Kosten, TR, Fontana, A, Sernyak, MJ, Rosenheck, R. Benzodiazepine use in posttraumatic stress disorder among veterans with substance abuse. J Nerv Ment Dis. 2000;188:454–459.CrossRefGoogle ScholarPubMed
89.Joffe, RT, Levitt, AJ, Sokolov, ST. Augmentation strategies: focus on anxiolytics. J Clin Psychiatry. 1996;57(suppl 7):25–31.Google ScholarPubMed
90.Landen, M, Bjorling, G, Agren, H, Fahlen, T. A randomized, double-blind, placebo-controlled trial of buspirone in combination with an SSRI in patients with treatment-refractory depression. J Clin Psychiatry. 1998;59:664–668.CrossRefGoogle ScholarPubMed
91.Appelberg, BG, Syvalahti, EK, Koskinen, TE, et al.Patients with severe depression may benefit from buspirone augmentation of selective serotonin reuptake inhibitors: results from a placebo-controlled, randomized, double-blind, placebo wash-in study. J Clin Psychiatry. 2001;62:448–452.CrossRefGoogle ScholarPubMed
92.Wells, BG, Chu, CC, Johnson, R, et al.Buspirone in the treatment of posttraumatic stress disorder. Pharmacotherapy. 1991;11:340–343.Google ScholarPubMed
93.Duffy, JD, Malloy, PF. Efficacy of buspirone in the treatment of posttraumatic stress disorder: an open trial. Ann Clin Psychiatry. 1994;6:33–37.CrossRefGoogle ScholarPubMed
94.LaPorta, LD, Ware, MR. Buspirone in the treatment of posttraumatic stress disorder. J Clin Psychopharmacol. 1994;14:133–134.CrossRefGoogle Scholar
95.Hamner, M, Ulmer, H, Home, D. Buspirone potentiation of antidepressants in the treatment of PTSD. Depress Anxiety. 1997;5:137–139.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
96.Dieperink, ME, Drogemuller, L. Zolpidem for insomnia related to PTSD. Psychiatr Serv 1999;50:421.CrossRefGoogle ScholarPubMed
97.Brophy, MH. Cyproheptadine for combat nightmares in post-traumatic stress disorder and dream anxiety disorder. Mil Med. 1991;156:100–101.CrossRefGoogle ScholarPubMed
98.Gupta, S, Popli, A, Bathhust, E, et al.Efficacy of cyproheptadine for nightmares associated with posttraumatic stress disorder. Compr Psychiatry. 1998;39:160–164.CrossRefGoogle ScholarPubMed
99.Rijnders, RJP, Laman, DM, van Diujn, H. Cyproheptadine for posttraumatic stress nightmares. Am J Psychiatry. 2000;157:1524–1525.CrossRefGoogle ScholarPubMed
100.Kinzie, JD, Leung, P. Clonidine in Cambodian patients with posttraumatic stress disorder. J Nerv Ment Dis. 1989;177:546–550.CrossRefGoogle ScholarPubMed
101.Harmon, RJ, Riggs, PD. Clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry. 1996;35:1247–1249.CrossRefGoogle ScholarPubMed
102.Pitman, RK, Sanders, KM, Zusman, RM, et al.Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002;51:189–192.CrossRefGoogle ScholarPubMed
103.Cahill, L, Prins, B, Weber, M, et al.Beta-adrenergic activation and memory for emotional events. Nature. 1994.371:702–704.CrossRefGoogle ScholarPubMed
104.Vaiva, G, Ducrocq, F, Jezequel, K, et al.Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biol Psychiatry. 2003;54:947–949.CrossRefGoogle ScholarPubMed
105. Risperdal [package insert]. Titusville, NJ: Janssen Pharmaceutica, LP; 2003.Google Scholar
106. Seroquel [package insert]. Wilmington, DE: AstraZeneca Phamaceuticals, LP; 2004.Google Scholar
107. Zyprexa [package insert]. Eli Lilly and Company: Indianopolis, IN; 2004.Google Scholar
108. Symbyax [package insert]. Eli Lilly and Company: Indianopolis, IN; 2004,Google Scholar
109.Hamner, MB, Frueh, BC, Ulmer, HG, et al.Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity. J Nerv Ment Dis. 2000;188:217–221.CrossRefGoogle ScholarPubMed
110.Hamner, MB. Psychotic features and combat-associated PTSD. Depress Anxiety 1997;5:34–38.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
111.David, D, Kutcher, GS, Jackson, EI, Mellman, TA. Psychotic symptoms in combat-related posttraumatic stress disorder. J Clin Psychiatry. 1999;60:29–32.CrossRefGoogle ScholarPubMed
112.Hamner, MB, Frueh, C, Ulmer, HG, et al.Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1999;45:846–852.CrossRefGoogle ScholarPubMed
113.Sautter, FJ, Brailey, K, Uddo, MM, Hamilton, MF, Beard, MG, Borges, AH. PTSD and comorbid psychotic disorder: comparison with veterans diagnosed with PTSD or psychotic disorder. J Trauma Stress 1999;12:73–88.CrossRefGoogle ScholarPubMed
114.Petty, F, Brannon, S, Casada, J, et al.Olanzapine treatment for post-traumatic stress disorder: an open-label study. Int Clin Psychopharmacol. 2001;16:331–337.CrossRefGoogle ScholarPubMed
115.Pivac, N, Kozaric-Kovacic, D, Muck-Seler, D. Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder. Psychopharmacology (Berl). 2004 Apr 3 [Epub ahead of print].Google Scholar
116.Manguno-Mire, GM, Johnson, JE, Wiley, J, et al. Olanzapine versus haloperidol in the treatment of posttraumatic stress disorder with comorbid psychotic symptoms. Poster presented at: annual meeting of the Institute on Psychiatric Services. October 29-November 2, 2003; Boston, Mass.Google Scholar
117.Butterfield, MI, Becker, ME, Connor, KM, Sutherland, S, Churchill, LE, Davidson, JR. Olanzapine in the treatment of post-traumatic stress disorder: a pilot study. Int Clin Psychopharmacol. 2001;16:197–203.CrossRefGoogle ScholarPubMed
118.Stein, MB, Kline, NA, Matloff, JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry. 2002;159:1777–1779.CrossRefGoogle ScholarPubMed
119.Stone, RC, Petty, F. Olanzapine treatment for torture survivors with PTSD – a case series. Poster presented at: annual meeting of the International Society for Traumatic Stress Studies. December 6-9, 2001; New Orleans, La.Google Scholar
120.Sokolski, KN, Denson, TF, Lee, RT, Reist, C. Quetiapine for treatment of refractory symptoms of combat-related post-traumatic stress disorder. Mil Med. 2003;168:486–489.CrossRefGoogle ScholarPubMed
121.Hamner, MB, Deitsch, SE, Brodrick, PS, et al.Quetiapine treatment in PTSD: an open trial of adjunctive therapy. J Clin Psychopharmacol. 2003;23:15–20.CrossRefGoogle ScholarPubMed
122.Robert, S, Hamner, MB, Kose, S, et al. Open-label quetiapine in PTSD: analysis of sleep data. Poster presented at: annual meeting of the International Society of Traumatic Stress Studies. October 29-November 2, 2003; Chicago, Ill.Google Scholar
123.David, D, DeFaria, L, LaPeyra, O, et al. Adjunctive risperidone treatment in combat veterans with chronic PTSD. Poster presented at: annual meeting of the Anxiety Disorders Association of America. March 27-30, 2003; Toronto, Canada.Google Scholar
124.Bartzokis, G, Freeman, TW, Roca, V. Risperidone treatment for combatrelated PTSD. Presented at: annual meeting of the American Psychiatric Association. May 5-10, 2001; New Orleans, La.CrossRefGoogle Scholar
125.Hamner, MB, Ulmer, HG, Faldowski, RA, et al.A randomized controlled trial of risperidone for psychotic features in PTSD. Int Clin Psychopharmacol. 2003;18:1–8.Google Scholar
126.Monnelly, EP, Ciraulo, DA, Knapp, C, et al.Low dose risperidone as adjunctive therapy for irritable aggression in PTSD. J Clin Psychopharmacol. 2003;23:193–196.CrossRefGoogle Scholar