Table 2.
Summary of randomized controlled trials for pharmacologic alternatives to antidepressants for treatment of PTSD.
| Study (year) | Sample (N) | Drug (mg/day) | Monotherapy / augmentation | Duration (weeks) | Outcome Measures | Was active drug superior to placebo? (p-value)* | |||
|---|---|---|---|---|---|---|---|---|---|
| Symptoms of PTSD | Cluster B | Cluster C | Cluster D | ||||||
| Atypical antipsychotics | |||||||||
| Bartzokis et al. (2005) | Veterans (65) | Risperidone (1 to 3) | Augmentation | 16 | CAPS | Yes (< .05) | No | No | Yes (< .01) |
| Hamner et al. (2003) | Veterans (37) | Risperidone (1 to 6) | Augmentation | 5 | CAPS | No | No | No | No |
| Reich et al. (2004) | Civilians (21) | Risperidone (0.5 to 8) | Augmentation | 8 | CAPS | No | No | No | No |
| CAPS-2 | Yes (.015) | Yes (< .001) | No | Yes (.006) | |||||
| Padala et al. (2006) | Civilians (20) | Risperidone (1 to 6) | Monotherapy | 12 | CAPS | Yes (.04) | NR | NR | NR |
| TOP-8 | Yes (.028) | NR | NR | NR | |||||
| Rothbaum et al. (2008) | Civilians (20) | Risperidone (mean: 2.1) | Augmentation | 8 | CAPS | No | NR | NR | NR |
| CGI | No | NR | NR | NR | |||||
| DTS | No | Yes, insomnia (.03) | NR | NR | |||||
| Monnelly et al. (2003) | Veterans (15) | Risperidone (0.5 to 2) | Augmentation | 6 | PCL-M | Yes (.02) | Yes (.001) | No | No |
| Stein et al. (2002) | Veterans (19) | Olanzapine (10 to 20) | Augmentation | 8 | CAPS | Yes (> .05) | NR | NR | NR |
| CGI | No | NR | NR | NR | |||||
| PSQI (nightmares) | NA | Yes (.01) | NA | NA | |||||
| Butterfield et al. (2001) | Civilians (15) | Olanzapine (5 to 20) | Monotherapy | 10 | TOP-8 | No | No | No | No |
| SPRINT | No | No | No | No | |||||
| Anticonvulsants | |||||||||
| Davis et al. (2008) | Veterans (82) | Divalproex (mean: 2,309) | Monotherapy | 8 | CAPS | No | No | No | No |
| CGI | No | NR | NR | NR | |||||
| DTS | No | NR | NR | NR | |||||
| TOP-8 | No | NR | NR | NR | |||||
| Tucker et al. (2007) | Civilians (38) | Topiramate (25 to 400) | Monotherapy | 12 | CAPS | No | Yes (.038) | No | No |
| DTS | No | No | No | No | |||||
| TOP-8 | Yes (.025) | No | No | No | |||||
| CGI | No | NR | NR | NR | |||||
| Lindley et al (2008) | Veterans (24) | Topiramate (50 to 200) | Augmentation | 7 | CAPS | No | Yes (< .05) | No | No |
| CGI | No | NR | NR | NR | |||||
| PGI-I | No | NR | NR | NR | |||||
| Davidson et al (2007) | Civilians (232) | Tiagabine (2 to 16) | Monotherapy | 12 | CAPS | No | NR | NR | NR |
| DTS | No | NR | NR | NR | |||||
| TOP-8 | No | NR | NR | NR | |||||
| CGI | No | NR | NR | NR | |||||
| Hertzberg et al. (1999) | Civilians and veterans (15) | Lamotrigine (50 to 500) | Monotherapy | 12 | DGRP | Yes | Yes | Yes | No |
| Adrenergic-inhibiting agents | |||||||||
| Neylan et al. (2006) | Veterans (63) | Guanfacin (1 to 3) | Augmentation | 8 | CAPS | No | No | No | No |
| IES-R | No | No | No | No | |||||
| SQI | No | No | No | No | |||||
| Raskind et al (2007) | Veterans (40) | Prazosin (mean: 13) | Augmentation | 8 | CAPS | No | Yes, nightmares (.02) | NR | NR |
| PSQI | NA | Yes (.008) | NR | NR | |||||
| CGI | Yes (.002) | NR | NR | NR | |||||
| Taylor et. al. (2008) | Civilians (13) | Prazosin (2 to 6) | Augmentation | 7 (crossover at week 3) | PCL-C | Yes (< .05) | NR | NR | NR |
| CGI | Yes (< .05) | NR | NR | NR | |||||
| Raskind et al. (2003) | Veterans (10) | Prazosin (mean: 9.5) | Augmentation | 20 (crossover at week 10) | CAPS | Yes (< .01) | Yes (< .001) | Yes (< .001) | Yes (< .001) |
| Yes (< .01) | Yes | Yes | Yes | ||||||
| Benzodiazepines | |||||||||
| Braun et al. (1990) | Civilians and veterans (16) | Alprazolam (1.5 to 6) | Monotherapy | 12 (crossover at week 5) | IES | No | No | No | NA |
When not reported, or no statistical significant difference was found, or was not reported by the authors.
Cluster B: reexperiencing; cluster C: avoidance/numbing; Cluster D: hyperarousal.
CAPS: Clinician-Administered PTSD Scale; CAPS-2: Clinician-Administered PTSD Scale, 1 week version; CGI: Clinical Global Impression; DGRP: Duke Global Rating for PTSD scale; DTS: Davidson Trauma Scale; IES-R: Impact Event Scale Revised; NA: not applicable; NR: not reported; PCL-M: Posttraumatic Stress Disorder Checklist Military version; PGI-I: Patient Global Impression – Improvement scale; PSQI: Pittsburgh Sleep Quality Index; SPRINT: Short PTSD Rating Interview; SQI: Subjective sleep quality; TOP-8: Treatment Outcomes PTSD Scale.