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Common PTSD drug not effective, study finds

The second-most widely prescribed antipsychotic drug for combat veterans with chronic post-traumatic stress disorder works no better than a placebo.

Veterans Affairs Department researchers found risperidone, a drug used to treat schizophrenia and other psychotic disorders, and often prescribed for the most severe symptoms of PTSD, did not reduce symptoms in 267 veterans who completed a study on the drug’s efficacy for PTSD.

Lead author Dr. John Krystal, chairman of the Yale School of Medicine psychiatry department, said the research strongly suggests clinicians should “be cautious” about prescribing risperidone, also known by the brand name Risperdal, for PTSD.

“This isn’t to say the medication does not work; we know it’s an effective antipsychotic,” Krystal said. “But for the core symptoms of PTSD, we didn’t see much improvement.”

Risperidone is one of a family of pharmaceuticals called “second-generation antipsychotics,” or SGAs, that are thought to block receptors in the brain for the chemical messenger dopamine, a neurotransmitter that affects movement, emotional response and the ability to feel pleasure or pain.

SGAs are used to treat severe mental conditions such as schizophrenia, bipolar depression and mania, and are thought to have fewer side effects than traditional psychotic medications.

Drugs in the same family as risperidone include the brands Seroquel, Clozaril and Abilify. These medications often are prescribed to veterans suffering from chronic PTSD to alleviate a host of symptoms associated with the illness, although they haven’t been approved by the Food and Drug Administration for PTSD.

The only two FDA-approved medications for treating PTSD are the antidepressants Zoloft and Paxil. Doctors often decide to prescribe antipsychotics for severe PTSD if patients haven’t responded to the approved medications, Krystal explained.

“It’s more of the art of psychiatry than the science,” he said.

Krystal urged caution in assuming that if risperidone doesn’t alleviate chronic PTSD symptoms, none of the SGAs will work for PTSD symptoms.

He said risperidone was found to relieve daydreams, nervousness and agitation, a few of the symptoms of chronic PTSD. The widest prescribed SGA for veterans, Seroquel, also known as quetiapine, usually is given at low doses as a sleep aid and not in high amounts as an antipsychotic and is effective for that purpose, he added.

Krystal suggested anyone taking risperidone for PTSD talk to their doctor about their cases to determine whether they should be weaned from it.

The researchers chose to test risperidone because it is widely prescribed, has a lower risk than other SGAs for side effects like weight gain and is relatively inexpensive, available as a generic drug.

Seroquel or quetiapine often is given to military personnel and veterans in combination with other medications to address the wide-ranging symptoms of PTSD. A warning has recently been added to the drug’s label that it can be dangerous or fatal if used in conjunction with some painkillers.

Military records show the number of deaths resulting from drug toxicity among active-duty members has tripled in the past decade, from 24 in 2001 to 68 in 2009. The synthetic narcotic methadone, often prescribed as a painkiller, contributed to at least 60 of those deaths, according to military records. But quetiapine also has been found among the prescriptions of those who have accidentally overdosed.

Although the results of the risperidone study were negative, Krystal described them as “good news.”

“The data should be helpful in reducing the likelihood that people are going to be treated with a medication that won’t be helpful,” he said. “It’s one of those cases where science can guide practice,” he said.

The study was published in the Aug. 1 issue of the Journal of the American Medical Association.

Staff writer Andrew Tilghman contributed to this story.