Antiepileptic drugs for the treatment of post-traumatic stress disorder

Abstract

Post-traumatic stress disorder (PTSD) is a disruptive, chronic, and relatively common disorder that is often difficult to treat. Many patients with PTSD are unresponsive, have only moderate or marginal responses, or have troubling side effects to first-line serotonin reuptake inhibitor treatment. Studies suggest that antiepileptic drugs (AEDs) may be an effective treatment alternative or adjunctive treatment for the symptoms of PTSD. Recent results from case reports and open and controlled studies on the efficacy and tolerability of AEDs in PTSD are reviewed here, and their methodological limitations are discussed when relevant. AEDs shown to be effective in double-blind, placebo-controlled trials of PTSD include lamotrigine, topiramate, and tiagabine. Other AEDs that appear promising in open-label trials of PTSD include carbamazepine, valproate, gabapentin, vigabatrin, phenytoin, and levetiracetam. Stress-activated limbic kindling may be involved in the pathogenesis of PTSD. The possibility that AEDs may be effective in the treatment of PTSD due to their antikindling effect is discussed, and suggestions for future research are made.

Comparing Gabapentin with Clonazepam for Residual Sleeping Problems following Antidepressant Therapy in Patients with Major Depressive Disorder: A Randomized Clinical Trial

“…It also increases cerebral GABA levels and may modulate the release of glutamate and norepinephrine [9,10]. These effects might explain its potential to improve sleep in different psychiatric disorders [16][17][18][19][20][21]27]. In this study, the efficacy of gabapentin for treating sleeping disturbances in MDD patients was comparable with that of clonazepam.…”

“…For example, patients with alcohol withdrawal have benefitted from gabapentin for their sleeping problems [27]. There are other studies indicating that sleeping disturbances associated with posttraumatic stress disorder have improved following treatment with gabapentin [19]. Gabapentin has also demonstrated efficacy for treating manic patients with sleeping complaints [18].…”

“…In previous studies, gabapentin has been shown to improve sleep in patients with epilepsy [15], restless legs syndrome [16], alcohol withdrawal [17], bipolar mood disorder [18], post-traumatic stress disorder [19] and in premenopausal women [20]. Gabapentin has also been shown to be effective in treatment of primary insomnia [21].…”

The first general protocol forN-monoalkylation of sulfamate esters: benign synthesis ofN-alkyl Topiramate (anticonvulsant drug) derivatives

“…After completion of the reaction, the solvent was removed under reduced pressure, and the residue was separated by preparative TLC with petroleum ether/ethyl acetate (3:1) as an eluent to obtain the pure product. 13 …”

“…As a part of our continuing effort to design new routes for the preparation of biologically active organic compounds; herein, we report the synthesis of N-substituted Topiramate as an important sulfamate containing drug by the reaction of Topiramate with various alkyl halides in the presence of KF-Al 2 O 3 as an efficient solid base (Scheme 2 in a growing number of other applications such as treatment of bipolar disorders and posttraumatic stress disorders. [11][12][13] The search for structural improvement of Topiramate to produce less-toxic and more efficient agents for the treatment of seizure disorders is an ongoing struggle. [14] Derivatization of Topiramate at the sulfamate moiety provides Topiramate analogs that are immunologically similar to Topiramate.…”