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Drug Therapy of Post-traumatic Stress Disorder

Published online by Cambridge University Press:  02 January 2018

Jonathan Davidson*
Affiliation:
Department of Psychiatry, PO Box 3812, Duke University Medical Center, Durham, North Carolina 27710, USA

Abstract

Post-traumatic stress disorder (PTSD) is a recently introduced diagnosis. The disorder is quite common, yet often unrecognised, and leads to significant morbidity or mortality. Effective treatment often entails use of psychotropic medication. Only recently has this become apparent, and awareness of the role of drug therapy in PTSD remains limited. A number of studies have indicated efficacy for antidepressant, mood-stabilising, anticonvulsant and antianxiety medications. This review describes the role of pharmacotherapy, by examining issues of diagnosis and recognition of PTSD, the theoretical basis for drug use, goals of drug treatment, dose ranges, and clinical application of psychotropic drugs.

Type
Review Articles
Copyright
Copyright © Royal College of Psychiatrists, 1992 

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References

American Psychiatric Association (1960) Diagnostic and Statistical Manual of Mental Disorders (DSM–III) (3rd edn). Washington, DC: APA.Google Scholar
Anisman, H. L. & Sklar, L. S. (1979) Catecholamine depletion in mice upon exposure to stress: mediation of the escape deficits produced by inescapable shock. Journal of Comprehensive Physiological Psychology, 93, 610625.CrossRefGoogle ScholarPubMed
Anisman, H. L., Ritzh, M. & Sklar, L. S. (1981) Noradrenergic and dopaminergic interactions in escape behavior: analysis of uncontrollable stress effects. Psychopharmacology, 74, 263268.CrossRefGoogle ScholarPubMed
Antelman, S. M. (1988) Time-dependent sensitization as the cornerstone for a new approach to pharmacotherapy: drugs as foreign/stressful stimuli. Drug Developmental Research, 14, 130.CrossRefGoogle Scholar
Birkhimer, L. J., DeVane, C. L. & Muniz, C. E. (1985) Post traumatic stress disorder: characteristics and pharmacological response in the veteran population. Comprehensive Psychiatry, 26, 304310.CrossRefGoogle Scholar
Bleich, A., Siegel, B., Garb, R., et al (1986) Post traumatic stress disorder following combat exposure: clinical features and psychopharmacological response. British Journal of Psychiatry, 149, 365369.CrossRefGoogle Scholar
Boehnlein, J. K., Kinzie, J. D., Ben, R., et al (1985) One year follow-up study of post traumatic stress disorder among survivors of Cambodian concentration camps. American Journal of Psychiatry, 142, 956959.Google ScholarPubMed
Breslau, N., Davis, G. C., Andreski, P., et al (1990) Traumatic events and post traumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 218222.Google Scholar
Cassella, J. V. & Davis, M. (1985) Fear enhanced acoustic startle is not attenuated by acute or chronic imipramine treatment in rats. Psychopharmacology, 87, 268282.CrossRefGoogle ScholarPubMed
Davidson, J. R. T. (1989) Post-traumatic stress disorder. In Diagnosis and Treatment of Anxiety Disorders: A Physician's Handbook (eds McGlynn, T. J. & Metcalf, H. L.), pp. 7784. Washington, DC: American Psychiatric Press.Google Scholar
Davidson, J. R. T., Walker, J. I. & Kilts, C. D. (1987) A pilot study of phenelzine in post-traumatic stress disorder. British Journal of Psychiatry, 150, 252255.CrossRefGoogle ScholarPubMed
Davidson, J. R. T. & Nemeroff, C. B. (1989) Pharmacotherapy in post traumatic stress disorder: historical and clinical considerations and future directions. Psychopharmacology Bulletin, 25, 422425.Google ScholarPubMed
Davidson, J. R. T. & Smith, R. D. (1990) Traumatic experiences in psychiatric outpatients. Journal of Traumatic Stress, 3, 459476.CrossRefGoogle Scholar
Davidson, J. R. T., Kudler, H. S., Smith, R. D., et al (1990) Treatment of post traumatic stress disorder with amitriptyline and placebo. Archives of General Psychiatry, 4, 259269.CrossRefGoogle Scholar
Davidson, J. R. T., Roth, S. & Newman, E. (1991a) Treatment of post traumatic stress disorder with fluoxetine. Journal of Traumatic Stress, 4, 419423.Google Scholar
Davidson, J. R. T., Hughes, D., Blazer, D. G., et al (1991b) Post traumatic stress disorder in the community: an epidemiological study. Psychological Medicine, 21, 713721.CrossRefGoogle ScholarPubMed
Dunner, F. J., Edwards, W. P. & Copeland, P. C. (1985) Clinical Efficacy of Alprazolam in PTSD Patients. Abstracts: New Research, American Psychiatric Association, 138th Annual Meeting. Los Angeles.Google Scholar
Famularo, R., Kinscherff, R. & Fenton, T. (1988) Propranolol treatment for childhood post traumatic stress disorder, acute type. American Journal of Diseases of Childhood, 142, 12441247.CrossRefGoogle ScholarPubMed
Frank, J. B., Giller, E. L., Kosten, T., et al (1988) A randomized clinical trial of phenelzine and imipramine for post traumatic stress disorder. American Journal of Psychiatry, 145, 12891291.Google Scholar
Friedman, M. J. (1988) Towards rational pharmacotherapy for post traumatic stress disorder: an interim report. American Journal of Psychiatry, 145, 281285.Google Scholar
Kandel, E. (1983) From metapsychology to molecular biology: explorations into the nature of anxiety. American Journal of Psychiatry, 140, 12771293.Google ScholarPubMed
Kinzie, J. D. & Leung, P. (1989) Clonidine in Cambodian patients with post traumatic stress disorder. Journal of Nervous and Mental Disease, 177, 546550.CrossRefGoogle Scholar
Kitchner, I. & Greenstein, R. (1985) Low dose lithium carbonate in the treatment of post traumatic stress disorder: brief communication. Military Medicine, 150, 378381.CrossRefGoogle ScholarPubMed
Kolb, L. C., Burris, B. C. & Griffiths, S. (1984) Propranolol and clonidine in the treatment of post traumatic disorders of war. In Post Traumatic Stress Disorder: Psychological and Biological Sequelae (ed. Van der Kolk, B. A.), pp. 97107. Washington, DC: American Psychiatric Press.Google Scholar
Krystal, J. H. (1990) Animal models for post traumatic stress disorder. In Biological Assessment and Treatment of Post Traumatic Stress Disorder (ed. Giller, E. L. Jr), pp. 126. Washington, DC: American Psychiatric Press.Google Scholar
Krystal, J. H., Kosten, T. R., Southwick, S., et al (1989) Neurobiological aspects of PTSD: a review of clinical and preclinical studies. Behavior Therapy, 20, 177198.CrossRefGoogle Scholar
Lipper, S., Davidson, J. R. T., Grady, T. A., et al (1986) Preliminary study of carbamazepine in post traumatic stress disorder. Psychosomatics, 27, 849854.CrossRefGoogle ScholarPubMed
Lowenstein, R. J., Hornstein, N. & Farber, B. (1988) Open trial of clonazepam in the treatment of post traumatic stress symptoms in multiple personality disorder. Dissociation, 1, 312.Google Scholar
McDougle, C., Southwick, S., StJames, R., et al (1990) An open trial of fluoxetine. PTSD Research Quarterly, Summer 1990, 7.Google Scholar
Post, R. M. & Kopanda, R. T. (1976) Cocaine, kindling and psychosis. American Journal of Psychiatry, 133, 627634.Google ScholarPubMed
Reist, C., Kauffman, C. D. & Haier, R. J. (1989) A controlled trial of desipramine in 18 men with post traumatic stress disorder. American Journal of Psychiatry, 146, 513516.Google Scholar
Roth, W. T. (1988) The role of medication in post traumatic therapy. In Post Traumatic Therapy and Victims of Violence (ed. Ochberg, F. M.), pp. 3956. New York: Brunner Mazel.Google Scholar
Sargant, W. W. & Slater, E. (1940) Acute war neuroses. Lancet, 140, 12.CrossRefGoogle Scholar
Sargant, W. W. & Slater, E. (1972) The use of drugs in psychotherapy. In An Introduction to Physical Methods of Treatment in Psychiatry (eds Sargant, W. W. & Slater, E.), pp. 142162. New York: Science House.Google Scholar
Shestatsky, M., Greenberg, D. & Lerer, B. (1988) A controlled trial of phenelzine in post traumatic stress disorder. Psychiatry Research, 24, 149155.CrossRefGoogle Scholar
Van der Kolk, B. A. (1983) Psychopharmacological issues in post traumatic stress disorder. Hospital and Community Psychiatry, 34, 683691.Google Scholar
Van der Kolk, B. A. (1987) The drug treatment of post traumatic stress disorder. Journal of Affective Disorders, 13, 203213.CrossRefGoogle ScholarPubMed
Van der Kolk, B. A., Greenberg, M., Boyd, H., et al (1985) Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress disorder. Biological Psychiatry, 20, 314325.CrossRefGoogle Scholar
Van der Kolk, B. A., Pitman, R. K., Orr, S. P., et al (1989) Endogenous opioids, stress-induced analgesia and post traumatic stress disorder. Psychopharmacology Bulletin, 25, 108112.Google Scholar
Wise, M. (1983) Post traumatic stress disorder: the human reaction to catastrophe. Drug Therapy, 3, 97105.Google Scholar
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