Comment: This evidence comes from studies where most of the participants had risperidone or olanzapine added to other medication regimens to which they had not adequately responded. Veterans with chronic PTSD are well represented in these studies.

The fact that this literature highlights severely affected, treatment refractory veterans would seem of particular interest to VA. Although it would not be advisable to make clinical recommendations for the use of novel antipsychotic medications as a first-line therapy because of the nature of the evidence and concerns regarding their tolerability, it should be noted that three of the studies with few major limitations had positive results, and the remaining with a negative result had a very small total N (15) and should be considered separately as it evaluated olanzapine as a monotherapy.

Thomas A. Mellman, MD


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