Extended-release formulation of venlafaxine in the treatment of post-traumatic stress disorder
The Catholic University of Korea College of Medicine, Department of Psychiatry, Kangnam St. Mary's Hospital, Seoul 137-701, South Korea.Expert Review of Neurotherapeutics (Impact Factor: 2.78). 07/2007; 7(6):603-15. DOI: 10.1586/1473722.214.171.1243
There is abundant evidence for abnormalities of both norepinephrine and serotonin neurotransmitter systems in post-traumatic stress disorder (PTSD). Venlafaxine extended-release formulation (venlafaxine XR) is a serotonin and norepinephrine re-uptake inhibitor with antidepressant and anxiolytic properties relevant to the pathophysiology of PTSD. Venlafaxine XR is currently approved for the treatment of panic disorder, generalized anxiety disorder and social anxiety disorder, as well as major depression in adults, based on a number of randomized, double blind, placebo-controlled clinical trials. Limited data also demonstrate that venlafaxine XR maintains a therapeutic response for more than 6 months in these anxiety disorders. Venlafaxine XR has demonstrated short- and long-term efficacy for the treatment of PTSD in two recent randomized, double-blind, placebo-controlled clinical trials, although it has not been extensively studied for PTSD, compared with other anxiety disorders. This review focuses on the potential role of venlafaxine XR in the treatment of PTSD, based on currently available evidence.
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- "Fortunately, there have been significant advances in both the pharmacotherapy and psychotherapy of PTSD (Pratchett et al., 2011). The selective serotonin re-uptake inhibitors (SSRIs) and the serotonin–norepinephrine re-uptake inhibitors (SNRIs) are now accepted as firstline pharmacotherapy for PTSD (Asnis et al., 2004; Ursano et al., 2004; Stein et al., 2006; Marshall et al., 2007; Pae et al., 2007). Unfortunately, up to 40% of participants in clinical trials fail to respond adequately to these agents (Rasmussen, 2006; Stein et al., 2006). "
ABSTRACT: Although there have been important advances in the treatment of posttraumatic stress disorder (PTSD), many patients fail to respond to first-line pharmacotherapy. Limited evidence suggests that second generation antipsychotics may have a role to play as monotherapy in PTSD. We undertook a randomized, placebo-controlled study using flexible-dose olanzapine monotherapy for 8 weeks in 28 adult male and female participants (mean age: 40.75 ± 11.59 years) with non-combat related chronic PTSD. Data were analysed with repeated measures analysis of variance, using an intention to treat, last observation carried forward approach. The olanzapine group (n = 14) demonstrated significantly greater improvement on the Clinician Administered PTSD Scale from baseline to endpoint than the placebo group (n = 14) (F = 5.71, p = 0.018). Olanzapine was generally well tolerated, with no serious adverse events recorded. Substantial weight gain (6-10 kg) was, however, reported in 6/14 participants in the olanzapine group. To our knowledge, this is the first controlled evidence of the efficacy of olanzapine monotherapy in an exclusively non-combat related chronic PTSD group. Despite the small sample size, these data suggest that olanzapine may have a role in the treatment of PTSD. These findings warrant replication in a larger sample.
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- "Also, this study could not address the combinatorial impact of blockade of serotonin and norepinephrine transporters , ie, SNRIs. These drugs have shown preliminary Noradrenergic vs serotonergic IL Petrakis et al efficacy for PTSD (Davidson et al, 2006; Pae et al, 2007; Richelson, 2003). Their efficacy in AD is untested. "
ABSTRACT: The wars in Iraq and Afghanistan are associated with high rates of post-traumatic stress disorder (PTSD) and comorbid alcohol use disorders. The pharmacotherapy of these comorbid conditions has received relatively little study. The current study compared the serotonin uptake inhibitor, paroxetine, to the norepinephrine uptake inhibitor, desipramine. It also evaluated the adjunctive efficacy of the Food and Drug Administration (FDA)-approved alcoholism pharmacotherapy, naltrexone, relative to placebo. Four groups of predominately male veterans (n=88) meeting current diagnostic criteria for both alcohol dependence (AD) and PTSD were randomly assigned under double-blind conditions to one of four groups: paroxetine+naltrexone; paroxetine+placebo; desipramine+naltrexone; desipramine+placebo. Main outcome measures included standardized scales that assessed symptoms of PTSD and alcohol consumption. Paroxetine did not show statistical superiority to desipramine for the treatment of PTSD symptoms. However, desipramine was superior to paroxetine with respect to study retention and alcohol use outcomes. Naltrexone reduced alcohol craving relative to placebo, but it conferred no advantage on drinking use outcomes. Although the serotonin uptake inhibitors are the only FDA-approved medications for the treatment of PTSD, the current study suggests that norepinephrine uptake inhibitors may present clinical advantages when treating male veterans with PTSD and AD. However, naltrexone did not show evidence of efficacy in this population. This study was registered with ClinicalTrials.gov, registration number NCT00338962 and URL: http://clinicaltrials.gov/ct2/show/NCT00338962?term=desipramine+AND+alcohol+dependence+AND+depression&recr=Closed&rank=1.Keywords: alcohol and alcoholism; psychopharmacology; PTSD; naltrexone; veterans; comorbidity
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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.
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