Levetiracetam for treatment-refractory posttraumatic stress disorder.
ABSTRACT To assess the use of levetiracetam, a novel anticonvulsant agent, in the treatment of refractory posttraumatic stress disorder (PTSD).
Retrospective analysis was conducted of 23 patients with DSM-IV diagnosis of PTSD who, after being deemed partial or nonresponders to antidepressant therapy, received levetiracetam in a naturalistic fashion. The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). Secondary outcome measures included the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impressions-Severity of Illness scale (CGI-S), and Clinical Global Impressions-Improvement scale (CGI-I).
Levetiracetam at a mean+/-SD dose of 1967+/-650 mg/day for 9.7+/-3.7 weeks was generally well tolerated. Nineteen patients (83%) were taking at least 1 concomitant medication. Patients were severely ill with a mean baseline PCL-C score of 67.2+/-9.4, CGI-S score of 6.0+/-0.7, and HAM-A score of 26.8+/-4.9. Patients improved significantly on all measures (p<.001). Thirteen patients (56%) met responder criteria at endpoint (PCL-C mean change=23.5, CGI-I score<or=2), and 6 (26%) met remission criteria (CGI-S score<or=2). Adverse events were generally mild, and no patients discontinued levetiracetam because of side effects.
These preliminary data suggest that levetiracetam may be an effective treatment in combination with antidepressant therapy for patients with PTSD who remain symptomatic after initial intervention.
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ABSTRACT: INTRODUCTION Anxiety disorders are chronic conditions that may require long-term drug treatments. Antidepressants represent the current gold standard but they fail in up to one-third of patients. Moreover, benzodiazepines, currently used in the acute treatment, are limited by the high risk of tolerance, dependence, and abuse. OBJECTIVES This paper is aimed at reviewing international literature on the use of anticonvulsant drugs in anxiety disorders. METHODS References were identified by searches of Medline/PubMed and PsychINFO. Only papers published in English were reviewed. RESULTS Despite a considerable number of open studies and anecdotal reports, the number of controlled studies is scanty. The majority of publications have several methodological limitations including inadequate sample size; lack of placebo control; the use of different outcome measures; and lack of controlling for patient variables such as comorbidity, diagnostic subtype, and concomitant medications. Pregabalin is the only anticonvulsant with good evidence in generalized anxiety disorder. Pregabalin and gabapentin may be promising in social phobia but further controlled studies are needed. A number of compounds are still at an early stage of evidence and may deserve further controlled trials: topiramate in posttraumatic stress disorder and obsessive compulsive disorder, valproate and gabapentin in panic disorder. CONCLUSION Anticonvulsant drugs may be valuable options in some selected patients with difficult to treat anxiety disorders refractory to first-line agents. Further studies are warranted to identify specific clinical phenotypes where anticonvulsants may be successfully used in the acute and long-term treatment of anxiety disorders.
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ABSTRACT: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.BMC Psychiatry 07/2014; 14(Suppl 1):S1. DOI:10.1186/1471-244X-14-S1-S1 · 2.24 Impact Factor
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ABSTRACT: Background When treating Post Traumatic Stress Disorder (PTSD) we must consider its complexity as it presents a variety of often contrasting symptoms. The guidelines provided by the Society for Traumatic Stress Studies (ISTSS) consistantly suggests psychotherapy as the first course of action to be taken in both acute and cronic states of PTSD and recommends combining pharmacological treatment only in severe PTSD. However, considering the complexity of this clinical picture and the many neurobiological alterations in PTSD, medication seems to be a fundamental “ingredient” in the treatment of this disorder.Quaderni Italiani di Psychiatria 06/2009; 28(2):79-88. DOI:10.1016/j.quip.2008.11.013