Pharmacology for sleep disturbance in PTSD

Lipinska, Gosia; Baldwin, David S.; Thomas, Kevin G. F.

doi:10.1002/hup.2522

Cited by 45 publications

(25 citation statements)

References 68 publications

(85 reference statements)

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“…Despite this, the evidence base for treatment of sleep disturbance in PTSD is relatively scant. Recent review of the literature supports the use of prazosin as a first-line agent for both insomnia and nightmares in PTSD (45). …”

Section: Post-traumatic Stress Disordermentioning

confidence: 99%

An Update on the Use of Sedative-Hypnotic Medications in Psychiatric Disorders

Creado

Plante

2016

Curr Psychiatry Rep

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Sleep disturbance is a common clinical problem experienced by patients with a wide range of psychiatric disorders. Accumulating evidence has demonstrated that insomnia is a comorbid process that affects the course and treatment of a number of forms of mental illness. The efficacy and safety of sedative-hypnotic medications has largely been established in patients who do not have comorbid psychiatric disorders, underscoring the need for further research in this sphere. This review summarizes pertinent findings in the recent literature that have examined the role of hypnotic medication in the treatment of psychiatric illness, and highlights potential areas that may prove fruitful avenues of future research.

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Section: Post-traumatic Stress Disordermentioning

confidence: 99%

An Update on the Use of Sedative-Hypnotic Medications in Psychiatric Disorders

Creado

Plante

2016

Curr Psychiatry Rep

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“…90,91 High-level evidence supports use of eszopiclone, risperidone, and olanzapine as an adjunct therapy in treatment for PTSD-related insomnia and nightmares. 92 Davidson 93 develops a case that tricyclic antidepressants deserve to be re-examined in PTSD, noting the residual morbidity of many patients with poor response to the current evidence-based therapies, although these therapies are more strongly anticholinergic and far more dangerous in overdose than are SSRIs or SNRIs.…”

Section: Implications For Practicementioning

confidence: 99%

Post-traumatic stress disorder and cancer

Cordova

Riba

Spiegel

2017

The Lancet Psychiatry

324

290

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Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.

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“…The ability of FAAH inhibition to selectively influence the autonomic, but not neuroendocrine, stress response is particularly interesting in the context of PTSD. Hyperarousal is a core feature of PTSD and contributes to a host of negative consequences, such as difficulties with sleep initiation and maintenance (63). Patients with comorbid PTSD and alcohol use disorder carrying the loss-of-function FAAH allele demonstrate a greater improvement in the PTSD symptom of hyperarousal.…”

Section: Faah Inhibition In Healthy Humansmentioning

confidence: 99%

Elevated Anandamide, Enhanced Recall of Fear Extinction, and Attenuated Stress Responses Following Inhibition of Fatty Acid Amide Hydrolase: A Randomized, Controlled Experimental Medicine Trial

Mayo

Asratian

Lindé

et al. 2020

Biological Psychiatry

162

105

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BACKGROUND: Posttraumatic stress disorder, an area of large unmet medical needs, is characterized by persistence of fear memories and maladaptive stress responses. In rodents, elevation of the endocannabinoid anandamide due to inhibition of fatty acid amide hydrolase (FAAH) facilitates fear extinction and protects against the anxiogenic effects of stress. We recently reported that elevated anandamide levels in people homozygous for a loss-of-function FAAH mutation are associated with a similar phenotype, suggesting a translational validity of the preclinical findings. METHODS: In this double-blind, placebo-controlled experimental medicine study, healthy adults were randomized to an FAAH inhibitor (PF-04457845, 4 mg orally, once daily; n = 16) or placebo (n = 29) for 10 days. On days 9 and 10, participants completed a task battery assessing psychophysiological indices of fear learning, stress reactivity, and stress-induced affective responses. RESULTS: FAAH inhibition produced a 10-fold increase in baseline anandamide. This was associated with potentiated recall of fear extinction memory when tested 24 hours after extinction training. FAAH inhibition also attenuated autonomic stress reactivity, assessed via electrodermal activity, and protected against stress-induced negative affect, measured via facial electromyography. CONCLUSIONS: Our data provide preliminary human evidence that FAAH inhibition can improve the recall of fear extinction memories and attenuate the anxiogenic effects of stress, in a direct translation of rodent findings. The beneficial effects of FAAH inhibition on fear extinction, as well as stress-and affect-related behaviors, provide a strong rationale for developing this drug class as a treatment for posttraumatic stress disorder.

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Pharmacology for sleep disturbance in PTSD

Cited by 45 publications

References 68 publications

An Update on the Use of Sedative-Hypnotic Medications in Psychiatric Disorders

An Update on the Use of Sedative-Hypnotic Medications in Psychiatric Disorders

Post-traumatic stress disorder and cancer

Elevated Anandamide, Enhanced Recall of Fear Extinction, and Attenuated Stress Responses Following Inhibition of Fatty Acid Amide Hydrolase: A Randomized, Controlled Experimental Medicine Trial

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