Valproate Therapy for Chronic, Combat-Induced Posttraumatic Stress Disorder

Petty, Frederick; Davis, Lori L.; Nugent, Alexandria L.; Kramer, Gerald L.; Teten, Andra L.; Schmitt, Andrew L.; Stone, Robert C.

doi:10.1097/00004714-200202000-00021

Cited by 42 publications

(20 citation statements)

References 8 publications

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“…Three studies of benzodiazepines in PTSD have failed to demonstrate efficacy and may even be suggestive of clinical deterioration (Braun et al 1990;Gelpin et al 1996;Mellman et al 1998). Several other drugs with purported GABAergic activity have demonstrated benefit in PTSD, albeit in small, open-label studies: carbamazepine (Lipper et al 1986;Wolf et al 1988); valproate (Fesler 1991;Clark et al 1999;Petty et al 2002); and topiramate (Berlant and van Kammen 2002). Our data with the SGRI tiagabine provide a somewhat more encouraging picture, at least as far as the open-label phase is concerned.…”

Section: Discussionmentioning

confidence: 99%

Tiagabine for posttraumatic stress disorder: effects of open-label and double-blind discontinuation treatment

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Tiagabine for posttraumatic stress disorder: effects of open-label and double-blind discontinuation treatment

et al. 2005

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“…Divalproex improves symptoms of irritability and aggression in patients with personality disorders, in particular borderline personality disorder (Frankenberg et al, 2002;Hollander et al, 2001a;Kavoussi and Coccaro, 1998;Wilcox, 1995;Stein et al, 1995a). In addition, improvements have been noted following treatment with divalproex in patients with behavioral dyscontrol following traumatic brain injury (Horne and Lindley, 1995), temper outbursts (Donavan et al, 1997(Donavan et al, , 2000Giakas et al, 1990), post-traumatic stress disorder (Petty et al, 2002;Fesler, 1991;Szymanski and Olympia, 1991), and agitation in the elderly (Tariot et al, 2001;Haas et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

Divalproex in the Treatment of Impulsive Aggression: Efficacy in Cluster B Personality Disorders

Hollander

Tracy

Swann

et al. 2003

Neuropsychopharmacol

203

157

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Impulsive aggressive behavior is common in psychiatric disorders and accounts for significant morbidity and mortality. However, little systematic treatment data exist from placebo-controlled trials for this symptom domain. This was a multicenter, randomized, doubleblind, placebo-controlled study in which outpatients with a score of X15 on the Aggression scale of the Overt Aggression ScaleModified (OAS-M) and who fulfilled DSM-IV criteria for Cluster B personality disorder (n ¼ 96), intermittent explosive disorder (n ¼ 116), or post-traumatic stress disorder (n ¼ 34) were randomized to divalproex sodium or placebo for 12 weeks duration. Based on average OAS-M Aggression scores over the last 4 weeks of treatment, a treatment effect was not observed in the intent-to-treat data set (combined across the three psychiatric disorders), but was observed in both intent-to-treat and evaluable data sets for patients with Cluster B personality disorders. In the Cluster B evaluable data set, statistically significant treatment differences favoring divalproex were also observed for component items of the OAS-M Aggression score, including verbal assault and assault against objects, as well as OAS-M Irritability score, and Clinical Global Impression (CGI)-Severity at multiple time points throughout the study. No treatment group difference was noted for overall premature discontinuation rate; however, across psychiatric diagnoses, 21 (17%) patients in the divalproex group prematurely discontinued because of an adverse event, as compared to 4 (3%) patients in the placebo group (po0.001). While a treatment effect was not observed when all diagnostic groups were combined, in a large subgroup of patients with Cluster B disorders, divalproex was superior to placebo in the treatment of impulsive aggression, irritability, and global severity.

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“…In a subsequent open-label study, Petty et al [77] were the first to investigate DVP as a monotherapy for PTSD. Unlike Fesler [19], Petty et al [77] used standardized rating scales in this 8-week trial of 30 combat-induced PTSD veterans (most were treatment refractory; 19 had current major depressive disorder). VPA significantly decreased all three PTSD symptom clusters and improved HAM-A and HAM-D scores.…”

Section: Gabapentinmentioning

confidence: 99%

Antiepileptic drugs for the treatment of post-traumatic stress disorder

Berlin

2007

Curr Psychiatry Rep

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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.

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Valproate Therapy for Chronic, Combat-Induced Posttraumatic Stress Disorder

Cited by 42 publications

References 8 publications

Tiagabine for posttraumatic stress disorder: effects of open-label and double-blind discontinuation treatment

Tiagabine for posttraumatic stress disorder: effects of open-label and double-blind discontinuation treatment

Divalproex in the Treatment of Impulsive Aggression: Efficacy in Cluster B Personality Disorders

Antiepileptic drugs for the treatment of post-traumatic stress disorder

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