Treatment of recent trauma survivors with benzodiazepines: a prospective study.
ABSTRACT Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder (PTSD), but have yielded limited results. Theory and retrospective research predict that early treatment may be more efficacious. Specifically, high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD. This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms.
Thirteen trauma survivors (the benzodiazepine group) were treated within 6.7 +/- 5.8 days after the trauma (range, 2-18) with either clonazepam (N = 10, 2.7 +/- 0.8 mg/day) or alprazolam (N = 3, 2.5 mg/day). Thirteen other trauma survivors, pair-matched with subjects in the active treatment group for gender and symptom severity in the first week after the trauma, constitute the control group. Both groups were reevaluated 1 and 6 months after the trauma for PTSD symptoms (Horowitz Impact of Event Scale; Mississippi Rating Scale for Combat-Related PTSD-civilian trauma version), PTSD status (Clinician Administered PTSD Scale), state anxiety, depression, and resting heart rate.
Subjects in the benzodiazepine group did not differ from controls in 1-month and 6-month PTSD and anxiety scores. Repeated measures ANOVA showed no group or group-by-time effect on psychometric measures. A trend toward group-by-time interaction in resting heart rate was noted (progressive decrease in the benzodiazepine group). Nine benzodiazepine subjects and 3 controls met PTSD diagnostic criteria 6 months after the trauma.
Contrary to expectations, the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness, while reducing physiologic expression of arousal.
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ABSTRACT: Post-traumatic stress disorder (PTSD) may be associated with long-lasting psychological suffering, distressing psychosocial disability, markedly reduced health-related quality of life, and increased morbidity and mortality in a subgroup of individuals in the aftermath of serious traumatic events. Both etiopathogenesis and treatment modalities of PTSD are best conceptualized within a biopsychosotial model. Pharmacotherapy may lay claim to a major role in the multimodal treatment approaches. Here we outline two different pharmacotherapeutic trends that aim to modify the encoding, consolidation, and rehearsal of traumatic memory in order to reduce the risk of PTSD immediately after trauma exposure on the one hand, and that endeavor to treat the clinical state of PTSD on the other. The theoretical rationales of both pharmacological strategies are the complex neurobiological underpinnings that characterize traumatic memory organization and clinical PTSD. Meanwhile, promising data from randomized controlled trials have been obtained for both approaches. Empirical evidence may inform clinicians in their clinical efforts for this special group of patients. The efficacy of several classes of drugs that have been investigated within a context of research should be evaluated critically and still have to stand the test of effectiveness in daily clinical practice. From a patient perspective, empirical results may serve as a psychoeducative guideline to what pharmacotherapeutic approaches may realistically achieve, what their risks and benefits are, and what their limits are in contributing to reducing the often major chronic suffering caused by serious traumatic events. Ethical issues have to be considered, particularly in the context of pharmacological strategies projected to prevent PTSD in the aftermath of traumatic exposure.Dialogues in clinical neuroscience 06/2014; 16(2):227-37.
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ABSTRACT: RESUMEN: Las investigaciones sobre el uso de psicofármacos en el trastorno por estrés postraumático son numerosas y han demostrado que no todos los pacientes van a responder de igual manera a la farmacoterapia. Los psicofármacos se han utilizado de forma sintomática para alivio de síntomas como ansiedad, depresión o insomnio, pero también de forma presuntamente etiológica tras los hallazgos neurobiológicos del TEPT, como la hiperactividad del sistema nervioso simpático, las alteraciones del eje hipotálamo-hipofiso-adrenocortical, el sistema opioide endógeno, o las alteraciones de la fisiología del sueño, entre otros. Se han intentado definir estrategias psicofarmacológicas en el TEPT como la orientación por los aspectos sintomáticos ansiosos y depresivos fundamentalmente, o aquellas referidas a la gravedad del cuadro clínico. En el TEPT se han ensayado muchos fármacos para el tratamiento del mismo y aunque no hay protocolo establecido, la mayoría de estudios apoyan la mayor eficacia de los antidepresivos frente al resto y más en concreto de sertralina (Comité de Expertos, FDA). Sin embargo, otros grupos farmacológicos como ansiolíticos, estabilizadores del ánimo o antipsicóticos han demostrado una importante utilidad.
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ABSTRACT: This article reviews the various current treatment options of posttraumatic stress disorder (PTSD), a prevalent and disabling condition. The primary-source literature was reviewed using PubMed search, and sec-ondary-source review articles and chapters were also used. Evidence from several studies suggests that both psychopharmacologic and psychotherapeutic therapies can be effective in PTSD. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective pharma-cotherapy should be continued for at least 12 months. Psychotherapy, especially cognitive behavior therapy, is found to be effective in the treatment of PTSD. In addition to those therapies, eye movement desensitiza-tion and reprocessing therapy, and transcranial magnet-ic stimulation would be relatively new treatment options for PTSD.