Risperidone monotherapy for post-traumatic stress disorder related to sexual assault and domestic abuse in women

Abstract

Post-traumatic stress disorder is a common, chronic, and often disabling mental illness. Selective serotonin reuptake inhibitors are the usual first-line treatment for post-traumatic stress disorder, but many patients fail to respond adequately. Thus, other treatment options, including the atypical antipsychotics such as risperidone, need to be tested. Women between the ages of 19 and 64 years with post-traumatic stress disorder were enrolled. Symptom severity was rated at baseline using the Treatment Outcomes Post-traumatic Stress Disorder Scale-8, Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Clinician Administered Post-traumatic Stress Disorder Scale. After washout from other psychotropic medications, 20 participants were randomized to either risperidone or placebo. Total score on the Treatment Outcomes Post-traumatic Stress Disorder Scale-8 served as the primary outcome measure. Repeated-measures analysis of variance was followed by Newman-Keuls tests. A significant main effect exists for visits using the Treatment Outcomes Post-traumatic Stress Disorder Scale-8 raw score. For the treatment group, the difference between baseline Treatment Outcomes Post-traumatic Stress Disorder Scale-8 scores and treatment visit scores was significant beginning at visit 6 and continued through visit 11. No significant difference observed between baseline and any treatment visit for the placebo group. The Clinician Administered Post-traumatic Stress Disorder Scale, Hamilton Rating Scale for Anxiety, and Hamilton Rating Scale for Depression data revealed a similar pattern. In this small pilot study, risperidone monotherapy was more effective than placebo in the treatment of post-traumatic stress disorder.

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…There is also evidence for the efficacy of the antipsychotics risperidone (Padala et al, 2006), olanzapine (Carey et al, 2012) and the anticonvulsant topiramate; (Yeh et al, 2011). Medications which have not been found efficacious in placebo-controlled trials include citalopram, alprazolam, and the anticonvulsants tiagabine and divalproex.…”

Antipsicóticos, anticonvulsivantes, antiadrenérgicos e outras drogas: o que fazer quando o transtorno do estresse pós-traumático não responde aos inibidores seletivos da recaptação da serotonina?

“…Risperidone was used as a monotherapy in only one study. 6 Only the dimension of avoidance/numbing symptoms did not respond adequately to risperidone in the above mentioned studies. In open trials, most of them involving war veterans with chronic PTSD, risperidone showed to be useful for the decrease of episodes of waking up in the middle of the night and vivid dreams related to the trauma, with evident improvement during the three first weeks of treatment.…”

“…Atypical antipsychotics Risperidone was used in the treatment of PTSD in at least five randomized clinical trials. [3][4][5][6][7] In four of them, risperidone had superior results than placebo. In most of the studies, risperidone was added to the therapeutic scheme of the patients who had already been treated with other drugs.…”

Pharmacotherapy of Post-Traumatic Stress Disorder

“…However, post-hoc analyses did reveal an advantage for risperidone in terms of improved sleep. Only a single RCT of risperidone monotherapy in PTSD has been published (Padala et al 2006). In this 12-week study of women (N ¼ 20) with PTSD stemming from sexual assault or domestic abuse, flexibly dosed risperidone (mean dose of 2.62 mg) was well-tolerated and superior to placebo on the primary outcome measure -score on the 8-item Treatment Outcomes PTSD Scale, but not on secondary outcomes (CAPS, HAM-D, or HAM-A).…”