Antipsychotic medicine prescribed for PTSD doesn't work, new study says

A frequently prescribed antipsychotic medication for reducing symptoms of military-related post-traumatic stress disorder does not appear to be effective, according to a study published in today's issue of JAMA, the Journal of the American Medical Association.

PTSD is among the most common and disabling among psychiatric disorders for military personnel in combat.

Last year 408,167 veterans were treated for PTSD at veterans hospitals and clinics.

Symptoms can include flashbacks as the patient relives a dangerous event or experiences bad dreams, said Dr. Venkatesh Bhat, a staff psychiatrist at the Jerry L. Pettis Memorial Veterans Medical Center in Loma Linda.

PTSD patients often experience hyperarousal symptoms, where they are on edge and respond to routine events in an inappropriate way, he said.

People with severe PTSD symptoms "can lose touch with reality, start hearing and seeing things," Bhat said.

Antidrepressants are frequently prescribed for PTSD and within the Department of Veterans Affairs, 89 percent of veterans diagnosed with PTSD, and treated with pharmacotherapy, are prescribed a class of medication called a serotonin reuptake inhibitor, or SRI, which regulates the level of the hormone serotonin in the brain, the study said.

Serotonin influences a person's mood and emotions.

When the first line of SRIs do not benefit the patient, a newer second generation of this antipsychotic

drug class is often prescribed.

One of these, risperidone, was shown in this study of nearly 250 patients to have no more effect than a placebo, according to the team headed by Dr. John H. Krysal, of the VA Connecticut Healthcare System in West Haven, Conn.

Bhat said he has used risperidone and found that it did help some patients.

Dr. Ian A. Cook, a professor of psychiatry at the UCLA Semel Institute, said studies like this shouldn't be interpreted as a ban against a medication's use.

This study raises the question of whether there is a subgroup of PTSD patients who might benefit from its use, Cook said.

As personalized medicine evolves, more treatment decisions will be made on the match with an individual patient and less on the response for a large group, Cook said.

Bhat noted that patients with chronic and serious PTSD symptoms typically take four or five medications.

Many can have significant side effects. For that reason, it's important they provide relief to the patient or get discontinued.

Bhat said there has been promising - and somewhat surprising - beneficial results on the PTSD front from an older group of medications originally used to treat high blood pressure.

Cook said he is in the early phases of a clinical study on the use of low-dose electrical impulses from electrodes attached to the forehead as the patient sleeps.