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Study: Antipsychotic Drug Does Not Help Veterans With PTSD

Expert Calls for New Approaches to Treating PTSD in Veterans
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WebMD Health News
Reviewed by Laura J. Martin, MD

Aug. 2, 2011 -- Risperdal, an antipsychotic medication commonly prescribed to veterans with posttraumatic stress disorder (PTSD) when antidepressants have failed to help, does not alleviate the symptoms of PTSD, according to a new study in the Journal of the American Medical Association.

“[T]hese findings should stimulate careful review of the benefits of these medications in patients with chronic  PTSD,” the authors conclude.

Two antidepressant medications, Zoloft and Paxil, are the only drugs that the FDA has approved to treat PTSD. Women are more likely to benefit from them than men, and neither drug is very effective at treating those with a chronic form of disorder.

Prescribing Risperdal

The lack of approved options has led doctors who treat veterans with PTSD to prescribe antipsychotics on what’s known as an off-label basis, which is when doctors prescribe the drug for a use unapproved by the FDA.

Within the Veterans Administration, 20%, or nearly 87,000, veterans diagnosed with PTSD took an antipsychotic in 2009. One of these antipsychotics, Risperdal, is part of a class of drugs known as second-generation antipsychotics. This class accounts for 93.6% of all antipsychotic prescriptions given to veterans with PTSD.

VA researchers recruited 296 veterans who had severe, long-standing PTSD related to their military service. Study participants previously could not tolerate or failed to respond to two or more antidepressants.  The study was conducted at 23 VA medical centers around the country from 2007 to 2009, with a follow-up in February of 2010. Nearly three quarters of the veterans had served in Vietnam or earlier conflicts; the remaining participants served in Iraq or Afghanistan.

The veterans taking Risperdal showed no significant improvement in symptoms compared to those taking a placebo over the six month course of treatment. The rate of remission, for example, was 4% among the placebo group compared to 5% for those taking the medication. “Thus,” the authors conclude, “it is unlikely that clinicians could detect the magnitude of the [Risperdal] effect over placebo that was observed in this study.”

Innovation Is Needed

Finding effective forms of treatment is crucial, but it is not the only priority for veterans with PTSD. Changing the negative perceptions that many veterans have concerning mental health care is equally important to ensuring that they enter and complete treatment, according to an editorial published alongside the Risperdal study.

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