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
Brady, K., T. Pearlstein, G. M. Asnis, D. Baker, B. Rothbaum, C. R. Sikes, and G. M. Farfel. 2000. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association 283(14):1837-1844.
Connor, K. M., S. M. Sutherland, L. A. Tupler, M. L. Malik, and J. R. Davidson. 1999. Fluoxetine in post-traumatic stress disorder. Randomised, double-blind study. British Journal of Psychiatry 175:17-22.
Davidson, J. R., B. O. Rothbaum, B. A. van der Kolk, C. R. Sikes, and G. M. Farfel. 2001. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Archives of General Psychiatry 58(5):485-492.
Davidson, J., B. O. Rothbaum, P. Tucker, G. Asnis, I. Benattia, and J. J. Musgnung. 2006. Venlafaxine extended release in posttraumatic stress disorder: A sertraline- and placebo-controlled study. Journal of Clinical Psychopharmacology 26(3):259-267.
Friedman, M. J., C. R. Marmar, D. G. Baker, C. R. Sikes, and G. M. Farfel. 2007. Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a department of veterans affairs setting. Journal of Clinical Psychiatry 68(5):711-720.
Hertzberg, M. A., M. E. Feldman, J. C. Beckham, H. S. Kudler, and J. R. Davidson. 2000. Lack of efficacy for fluoxetine in PTSD: A placebo controlled trial in combat veterans. Annals of Clinical Psychiatry 12(2):101-105.
Marshall, R. D., K. L. Beebe, M. Oldham, and R. Zaninelli. 2001. Efficacy and safety of paroxetine treatment for chronic PTSD: A fixed-dose, placebo-controlled study. American Journal of Psychiatry 158(12):1982-1988.
Marshall, R. D., R. Lewis-Fernandez, C. Blanco, H. Simpson, S.-H. Lin, D. Vermes, W. Garcia, F. Schneier, Y. Neria, A. Sanchez-Lacay, and M. R. Liebowitz. 2007. A controlled trial of paroxetine for chronic PTSD, dissociation and interpersonal problems in mostly minority adults. Depression and Anxiety 24(2):77-84.
Martenyi, F., E. B. Brown, H. Zhang, A. Prakash, and S. C. Koke. 2002. Fluoxetine versus placebo in posttraumatic stress disorder. Journal of Clinical Psychiatry 63(3):199-206.