Antipsychotic Medications

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Category: Medical Options

What is it?

Antipsychotic medications are a large class of psycho-active drugs used to treat psychotic illness and some other conditions. The first generation of antipsychotics, known as typical antipsychotics, has been in use since the 1950s. Of the newer second generation drugs, known as atypical antipsychotics, some have been trialed for the treatment of some symptoms in PTSD patients which were resistant to other therapy.

The atypical antipsychotics which have been documented for PTSD are:

  • olanzapine (trade names include Zyprexa, Zalasta, Zolafren, Olzapin)
  • quetiapine (trade names include Seroquel and Ketipinor)
  • risperidone (trade names include Risperdal and Ridal)

How does it work?

Antipsychotic drugs produce a range of effects in the central nervous system by acting on the D2 receptors in the dopamine pathways of the brain. This means that dopamine released in these pathways has less effect, thus reducing symptoms.

Is it effective?

A large body of evidence exists on the use of atypical antipsychotics to treat psychosis, however there is only emerging research evidence regarding the use of these medications for PTSD symptoms. Some small studies have shown atypical antipsychotics to be effective when used as an adjunct to other therapies when PTSD symptoms are severe and resistant, and also when PTSD symptoms co-exist with psychosis.

Are there any disadvantages?

Side effects from atypical antipsychotics are not uncommon and include tachycardia, low blood pressure and lethargy. The drugs’ effects on the nervous system can cause extrapyramidal reactions including acute dystonias (uncontrollable muscle contractions), parkinsonism (muscle rigidity) and increased risk of seizures. Other side effects are possible and health practitioners should be made aware of any changes.

Where do you get it?

Antipsychotics can only be prescribed by registered health practitioners.

What are the evidence limitations?

The evidence base for atypical antipsychotic use in PTSD is poor. Studies to date have been on small numbers of patients and the methods of diagnosing PTSD were not reported in the reviewed literature. Most of the studies have been with veterans diagnosed with combat related PTSD and larger studies on wider populations are required to establish the effectiveness of these drugs for PTSD.

Recommendations

Evidence is emerging for the use of atypical antipsychotic medications for patients with certain types of PTSD presentations. Based on the current limited evidence, atypical antipsychotics cannot be recommended for the routine treatment of PTSD. It is important that antipsychotic treatment is only prescribed by a registered health professional, with appropriate assessment carried out prior to treatment as well as ongoing monitoring during the course of treatment.

Key References

Butterfield, MI, Becker, ME, Connor, KM, Sutherland, S, Churchill, LE & Davidson, JRT 2001, ‘Olanzapine in the treatment of posttraumatic stress disorder: a pilot study’, International Clinical Psychopharmacology, vol.16, pp. 197–203.

Cooper, J, Carty, J & Creamer, M 2005, ‘Pharmacotherapy for posttraumatic stress disorder: empirical review and clinical recommendations’, Australian and New Zealand Journal of Psychiatry, vol. 39, pp.674–682

Hamner, MB, Faldowski, RA, Ulmer, HG, et al. 2003, ‘Adjunctive risperidone treatment in post-traumatic stress disorder: a preliminary controlled trial of effects on comorbid psychotic symptoms’, International Clinical Psychopharmacology, vol. 18, pp. 1–8

Hamner, MB, Deitsch, SE, Brodrick, PS, et al. 2003, ‘Quetiapine treatment in patients with posttraumatic stress disorder: an open adjunctive therapy’, Journal of Clinical Psychopharmacology, vol. 23, pp. 15–20

Maher, MJ, Rego, SA & Asnis, GM 2006, ‘Sleep disturbances in patients with post-traumatic stress disorder. Epidemiology, impact and approaches to management’, CNS Drugs, vol. 20(7), pp. 567-590

Petty, F, Brannan, S, Casada, J, et al. 2001, ‘Olanzapine treatment for post-traumatic stress disorder: an open-label study’, International Clinical Psychopharmacology, vol. 16, pp. 331–337.

Schoenfeld, F, Marmar, C & Neylan, T 2004, ‘Current concepts in pharmacotherapy for posttraumatic stress disorder’, Psychiatric Services, vol. 55, pp. 519–531

Stein, MB, Kline, NA & Matloff, JL 2002, ‘Adjunctive olanzapine for SSRI-resistant combat related PTSD: a double-blind, placebo-controlled study’, American Journal of Psychiatry, vol. 159, pp.1777–1779,

Sokolski KN, Denson TF, Lee RT, et al. 2003, ‘Quetiapine for treatment of refractory symptoms of combat-related post-traumatic stress disorder’, Military Medicine, vol. 168, pp.486–489.

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