Aripiprazole for Post-traumatic Stress Disorder: A Systematic Review

Britnell, Sara R.; Jackson, Anna D.; Brown, Jamie N.; Capehart, Bruce P.

doi:10.1097/wnf.0000000000000251

Cited by 21 publications

(19 citation statements)

References 18 publications

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“…Aripiprazole with its high affinity for the Dopamine-2 and D3 receptors and its partial agonist/antagonist activity at the serotonin 5-HT 1A binding sites has been proven an effective agent for the treatment of psychotic and mood disorders. 90 Five cases of combat-related PTSD treated with aripiprazole (dose 15–30 mg/day) in combination with either sertraline or cognitive-behavioral psychotherapy showed a significant improvement, but not total resolution, of nightmares. 91 Only one patient discontinued treatment due to worsening insomnia.…”

Section: Approach To Managementmentioning

confidence: 99%

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

El-Solh

2018

NSS

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Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.

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Section: Approach To Managementmentioning

confidence: 99%

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

El-Solh

2018

NSS

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“…23,26 It is well known that post-traumatic stress disorder frequently causes nightmares; its pathophysiology is based on the dysfunction of noradrenaline and dopamine in the hippocampus, amygdala, and locus coeruleus, as well as dysfunction of the serotonin system. 26 Nightmares in patients with post-traumatic stress disorder have often been treated with antidepressants or atypical antipsychotics 27,28 -drugs that have the same action in the serotonergic system as YKS. Hence, the serotonergic action of YKS, which CZP lacks, may explain their differences with regard to improvements in the nature of dreams in patients with RBD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of yokukansan compared with clonazepam for rapid eye movement sleep behaviour disorder: a preliminary retrospective study

et al. 2020

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Aim: Rapid eye movement sleep behaviour disorder (RBD) is characterized by abnormal behaviours accordant with nightmares during rapid eye movement sleep and is considered a prodromal marker of dementia with Lewy body. Most common in the elderly population, RBD is generally treated with clonazepam (CZP), a long-term acting benzodiazepine antiepileptic. As such, alternative drugs for RBD are urgently needed to minimize the adverse effects peculiar to benzodiazepines. The efficacy of yokukansan (YKS), a traditional Japanese herbal medicine, on RBD was initially reported by Shinno et al. in 2008. However, no study has compared YKS with CZP. Therefore, this study aimed to clarify the possibility of using YKS as an alternative to CZP. Methods: This was a retrospective cohort study conducted at Jikei University Affiliated Hospital. The subjects were selected from 36 outpatients who had been diagnosed with RBD based on the International Classification of Sleep Disorders, third edition. Of the 23 who met the inclusion criteria but not the exclusion criteria, 11 were treated with YKS monotherapy, and 12 were treated with CZP monotherapy. The primary outcome was the total score on the Japanese version of the Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ-JP), and the secondary outcomes were the scores from the eight-item Short-Form Health Survey and factors 1 and 2 of the RBDQ-JP. Results: The mean total RBDQ-JP score significantly improved from 52.5 to 21.7 (P = 0.002) after treatment with YKS (mean dosage: 3.0 g/day), which was similar to the change after CZP treatment (from 43.8 to 21.3). On RBDQ-JP factor 1 (dream content), the mean score on five of six items significantly improved after treatment with YKS. There was no significant change in Short-Form Health Survey scores after treatment with either drug. Potassium concentrations were within the normal range in patients treated with YKS. Conclusions: The present results suggest that a small amount of YKS may be an alternative to CZP for RBD, without remarkable adverse events. Further study is needed to prospectively clarify the efficacy and safety of YKS in more detail.

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“…Aripiprazole is effective either as monotherapy or as adjunct for both PTSD [22] and OCD [19], although evidence of monotherapy in OCD is modest [26].…”

Section: Discussionmentioning

confidence: 99%

“…This clinical observation suggests that dopaminergic modulation of intrusive thoughts may be a research topic and therapeutic target of interest cutting across several diagnostic categories, including PTSD and OCD. On the other hand, aripiprazole has been suggested to act on PTSD symptoms via its serotoninergic activity on 5-HT1a receptors [22]. This effect, which is potentiated synergistically with SSRIs such as sertraline [28], could ameliorate depressive symptoms in the first place, with the improvement on both OCD and PTSD symptoms being potentially mediated by the effects on depressed mood.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation

Rossi

Niolu

Siracusano

et al. 2020

Case Reports in Psychiatry

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Several studies report on traumatic history in Obsessive Compulsive Disorder (OCD) and comorbidity between Posttraumatic Stress Disorder (PTSD) and OCD. First-line pharmacological treatments for both OCD and PTSD are primarily based on antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) such as Venlafaxine for PTSD. Second-Generation Antipsychotic (SGA) augmentation has shown good outcomes for nonresponsive OCD cases. However, evidence on the use of SGA in PTSD is more limited. In the present paper, we report on comorbid OCD-PTSD successfully treated with aripiprazole augmentation of sertraline. Shared psychopathological and pharmacological aspects of the disorders are discussed.

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Aripiprazole for Post-traumatic Stress Disorder: A Systematic Review

Abstract: Based on the reviewed literature, aripiprazole is a reasonable therapy option as monotherapy or adjunct therapy in patients with PTSD. Larger randomized controlled trials are needed to better understand the role of this atypical antipsychotic in patients with PTSD.

Cited by 21 publications

References 18 publications

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

Efficacy of yokukansan compared with clonazepam for rapid eye movement sleep behaviour disorder: a preliminary retrospective study

A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation

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