Antipsychotic fails to help veterans with chronic PTSD

Risperdal, an antipsychotic drug commonly prescribed to veterans with posttraumatic stress disorder (PTSD) when antidepressants fail to work, does not help numb the symptoms of the PTSD, according to a study published last week in the Journal of the American Medical Association.

Only two antidepressant medications, Zoloft and Paxil, are approved by the Food and Drug Administration (FDA) to treat PTSD, though neither drug has been shown to be effective at treating those with a chronic form of the condition. With few FDA-approved options available, doctors have begun prescribing Risperdal to patients when antidepressants fail to alleviate their symptoms.

Risperdal is normally used to treat symptoms of schizophrenia and bipolar disorder. Twenty percent, or nearly 87,000 veterans diagnosed with PTSD were prescribed antipsychotic medications in 2009.

PTSD can occur after someone goes through a traumatic event like combat, assault, or disaster. Most people have some stress reactions after a trauma. PTSD is diagnosed in patients when the reactions don’t go away over time or disrupt daily life. Symptoms include nightmares, hypervigilance, anxiety, depression, and flashbacks.

For the study, researchers looked at 296 patients from 23 Veteran Administration medical centers nationwide with severe, long-term PTSD related to their military service. All study participants could not tolerate or did not respond to two or more antidepressants. Each was given either Risperidone or a placebo along with additional therapies.

Researchers found that there was no significant improvement in symptoms in patients taking Risperidone compared to patients taking a placebo. For example, the rate of remission in the placebo group was 4 percent compared to 5 percent in the Risperidone group.

“Improving evidence-based treatments, therefore, must be paired with education in military cultural competency to help clinicians foster rapport and continued engagement with professional warriors,” writes Charles W. Hoge, MD, of Walter Reed Army Medical Center in Silver Spring, Md. “This includes sensitivity and knowledge in attending to difficult topics, such as grief and survivor’s guilt stemming from loss of team members, ethical dilemmas in combat, or situations associated with feelings of betrayal.”

Source: JAMA