Post-traumatic stress treatment

Indeed, 5-HT is also a substrate for the 5-HT transporter, itself an important player in the treatment of depression, and more recently for the whole range of anxiety disorders spectrum (GAD, OCD, social and other phobias, panic and post-traumatic stress disorders). It is the target for SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, paroxetine, fluvoxamine, and citalopram or the more recent dual reuptake inhibitors (for 5-HT and noradrenaline, also known as SNRIs) such as venlafaxine. Currently, there are efforts to develop triple uptake inhibitors (5-HT, NE, and DA). Further combinations are possible, e.g. SB-649915, a combined 5-HTia, 5-HT1b, 5-HT1d inhibitor/selective serotonin reuptake inhibitor (SSRI), is investigated for the treatment of major depressive disorder. 

Umbricht A, Hoover DR, Tucker MJ, et al Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection. Drug Alcohol Depend 69 263-272, 2003 Villagomez RE, Meyer TJ, Lin MM, et al Post-traumatic stress disorder among inner city methadone maintenance patients. Subst Abuse Treat 12 253—257, 1995 Mining E, Kosten TR, Kleber H Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83 567-575, 1988 Washton AM, Pottash AC, Gold MS Naltrexone in addicted business executives and physicians. J Clin Psychiatry 45 39 1, 1984 Wesson DR Revival of medical maintenance in the treatment of heroin dependence (editorial). JAMA 259 3314-3315, 1988... 

Post-traumatic stress disorder (PTSD) is a severe condition with a lifetime prevalence of about 12.5% in women and 6.2% in men (Pigott, 1999). About one in four individuals exposed to trauma develop the syndrome. Drug treatments are still being developed, mostly using antidepressants. Few systematic data are available on the pharmacoeconomics of the condition. 

Bandelow B, Zohar J, Hollander E, et al. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders. World J Biol Psychiatry 2002 3 171-199. 

A prospective, randomized, placebo-controlled trial of paroxetine in adults with chronic post-traumatic stress disorder (PTSD) was recently conducted (Marshall etal., 2007). The subjects were New Yorkers, predominantly female (67%) and Hispanic (65.4%). Seventy subjects entered the study and after a one week placebo lead-in, 52 subjects were randomized to placebo or paroxetine for ten weeks. The subjects were treated with a flexible dosage design (mean dosage, 40.4 mg/day). Dropout rates were 32% for paroxetine and 51.9% for placebo. There were no differences in rates of adverse effects between treatment arms. Paroxetine was superior to placebo in ameliorating the primary symptoms of PTSD (56% vs. 22.2%). 

The full complement of anxiety syndromes including panic, generalized anxiety, obsessive-compulsiveness, and post-traumatic stress disorder can arise in the after-math of TBI. In fact, anxiety may be the most common neuropsychiatric complication of TBI. Anxiety appears to be most likely to arise when the injury occurs to the right side of the brain. The treatment alternatives for post-TBl anxiety parallel those used when treating anxiety disorders and include serotonin-boosting antidepressants, buspirone (Buspar), and the benzodiazepines (see Table 12.1). 

In addition to their proven efficacy in the treatment of all types of depression, the SSRIs have been shown to be the drugs of choice in the treatment of panic disorder, obsessive-compulsive disorder, bulimia nervosa, and as an adjunct to the treatment of alcohol withdrawal and relapse prevention, premenstrual dysphoric disorder and post-traumatic stress disorder. The usefulness of these drugs in treating such a diverse group of disorders reflects the primary role of serotonin in the regulation of sleep, mood, impulsivity and food intake. 

The mechanisms of flashbacks are probably mixed. Some cases may be similar to post-traumatic stress disorder induced by a bad trip (Paton et al., 1973). Abraham (1983) suggested that some of the visual phenomena, such as trailing and after-images, were due to failure of inhibition in visual pathways, possibly mediated in the lateral geniculate nucleus which (in the macaque monkey) contains on-off colour neurons with receptor fields similar to those described in flashbacks. The neurochemical causes of such flashbacks, which can be very disturbing, remains elusive and attempts at treatment are usually ineffective. 

In recent years many of these primary care cases that would formerly have been seen as anxiety disorders have been portrayed as anxious-depressives and have led to treatment with antidepressants, in particular the more recent serotonin reuptake inhibitors. As part of this rebranding a variety of states such as panic disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder have appeared, along with more traditional disorders such as obsessive compulsive disorder (OCD). Many of these diagnoses are likely to lead to prescriptions of an SSRI although the evidence for benefit from SSRIs is poor except for OCD. 

I Unlabeled Uses Treatment of body dysmorphic disorder, fibromyalgia, hot flashes, post-traumatic stress duisorder, Raynaud s phenomena... 

Pynoos, R.S. and Nader, K. (1993) Issues in the treatment of post-traumatic stress disorder in children and adolescents. In Wilson, J. and Raphael, B., eds. The International Handbook of Traumatic Stress Syndromes Washington, DC American Psychiatric Press, pp. 535-549. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

Bryant, R.A. and Friedman, MBc. (2001) Medication and nonmedication treatments of post-traumatic stress disorder. Current Opinion in Psychiatry 14 119-123. 

Perrin, S., Smith, P., and Yule, W. (2000) The assessment and treatment of Post-traumatic Stress Disorder in children and adolescents. J Child Psychol Psychiatry 41 277—289. 

Famularo, R., Kinscherff, R., and Fenton, T. (1988) Propranolol treatment for childhood post-traumatic stress disorder, acute type. Am J Dis Child 142 1244-1247. 

Hickling, E.J., and Blanchard, E.B. (1997) The private practice psychologist and manual-based treatments post-traumatic stress disorder secondary to motor vehicle accidents [see comments]. Be-havi Rese Ther 35 191-203. 

Other comorbid conditions, such as obsessive-compulsive, conduct, eating, and post-traumatic stress disorders, have also been found to affect the treatment response and need to be addressed for the successful treatment of depressed youths (Birmaher et ah, 1996b Goodyer et ah, 1997 Brent et ah, 1998). 

Friedman, M.J. (1990) Interrelationships between biological mechanisms and pharmacotherapy of post-traumatic stress disorder. In Wolfe, M.E. and Mosnian, A.D. eds. Posttraumatic Stress Disorder Etiology, Phenomenology, and Treatment. Washington, DC American Psychiatric Press pp. 204-225. 

March, J.S. (1999) Assessment of pediatric post-traumatic stress disorder. In Saigh, P. and Bremner, J., eds. Posttraumatic Stress Disorder A Comprehensive Approach to Assessment and Treatment. Needham Heights, MA Allyn and Bacon, pp. 221—237. 

Southwick, S.M., Yehuda, R., Ciller, Charney, D.S. (1994) Use of tricyclics and monoamine oxidase inhibitors in the treatment of PTSD a quantitative review. In Marhurg, M.M., ed. Catecholamine Function in Post-traumatic Stress Disorder Emerging... 

Wells, G.B., Chu, C., and Johnson, R. (1991) Buspirone in the treatment of post-traumatic stress disorder. / Clin Psychiatry 55 517-511. 

Another important factor that may favor placebo responses in clinical studies is probably the patient recruitment strategy, as suggested by the following observation two almost identically designed studies with fluoxetine vs. placebo in the treatment of post-traumatic stress disorder (PTSD) were performed, but only one of them resulted in a significant difference between... 

Davidson, J.R., Colket, J.T. The eight-item treatment-outcome post-traumatic stress disorder scale a brief measure to assess treatment outcome in post-traumatic stress disorder. Int. Clin. Psvchopharmacol. 12(1), 41-45, 1997. 

The book concludes with Chapter 13 and Chapter 14 on disorders that require separate consideration. The first group includes Panic, Obsessive-Compulsive, Post-Traumatic Stress, Somatoform, and Dissociative disorders. Although traditionally these are classified as anxiety disorders, their symptoms and varied treatment responsivity require a separate series of discussions. Finally, certain groups of patients are considered in light of their specialized needs when contemplating psychotropic drug therapy. They include the pregnant patient, children and adolescents, the elderly, the personality disordered, as well as patients whose conditions are complicated by medical problems (e.g., the alcoholic patient the HIV-infected patient). 

Hamner MB, Frueh BC. Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with post-traumatic stress disorder. Int Clin Psychopharmacoi 1998 13 233-234. 

Baker DG, Diamond Bl, Gillette G, et al. A double-blind randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. 

Some of the growth in antidepressant use may be related to the broad application of these agents for conditions other than major depression. For example, antidepressants have received FDA approvals for the treatment of panic disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In addition, antidepressants are commonly used to treat pain disorders such as neuropathic pain and the pain associated with fibromyalgia. Some antidepressants are used for treating premenstrual dysphoric disorder (PMDD), mitigating the vasomotor symptoms of menopause, and treating stress urinary incontinence. Thus, antidepressants have a broad... 

To review the clinical description and pharmacological treatments for post traumatic stress disorder. 

Food and Drug Administration (FDA) approved the first clinical trial of MDMA (ecstasy) as a treatment for post-traumatic stress disorder (PTSD) in the United States. As of 2002 the proposed research waited for additional approvals. 

HT2 receptors might have played a causal role, because 5-HT2 receptor antagonists, such as nefazodone, can be helpful in the treatment of nightmares, for example in patients with post-traumatic stress disorder. 

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