Abstract
BackgroundIn order to confirm therapeutic effects of topiramate on posttraumatic stress disorder (PTSD) observed in a prior study, a new prospective, open-label study was conducted to examine acute responses in chronic, nonhallucinatory PTSD.MethodsThirty-three consecutive newly recruited civilian adult outpatients (mean age 46 years, 85% female) with DSM-IV-diagnosed chronic PTSD, excluding those with concurrent auditory or visual hallucinations, received topiramate either as monotherapy (n = 5) or augmentation (n = 28). The primary measure was a change in the PTSD Checklist-Civilian Version (PCL-C) score from baseline to 4 weeks, with response defined as a ≥ 30% reduction of PTSD symptoms.ResultsFor those taking the PCL-C at both baseline and week 4 (n = 30), total symptoms declined by 49% at week 4 (paired t-test, P < 0.001) with similar subscale reductions for reexperiencing, avoidance/numbing, and hyperarousal symptoms. The response rate at week 4 was 77%. Age, sex, bipolar comorbidity, age at onset of PTSD, duration of symptoms, severity of baseline PCL-C score, and monotherapy versus add-on medication administration did not predict reduction in PTSD symptoms. Median time to full response was 9 days and median dosage was 50 mg/day.ConclusionsPromising open-label findings in a new sample converge with findings of a previous study. The use of topiramate for treatment of chronic PTSD, at least in civilians, warrants controlled clinical trials.
Highlights
In order to confirm therapeutic effects of topiramate on posttraumatic stress disorder (PTSD) observed in a prior study, a new prospective, open-label study was conducted to examine acute responses in chronic, nonhallucinatory PTSD
All monotherapy patients were in the nonbipolar subgroup
Primary measures Reduction in PTSD Checklist-Civilian Version (PCL-C) symptoms Ninety-one percent of patients (30/33) with baseline PCLC measurements completed a PCL-C at week 4
Summary
In order to confirm therapeutic effects of topiramate on posttraumatic stress disorder (PTSD) observed in a prior study, a new prospective, open-label study was conducted to examine acute responses in chronic, nonhallucinatory PTSD. Posttraumatic stress disorder (PTSD) is a difficult-to-treat condition that over a lifetime affects approximately 10% of the general population [1]. The condition develops after traumatic events such as combat, terror activities, disaster, or rape, and has 3 main features: (1) reexperiencing the trauma through recollection, dreams, and reliving, (2) avoidance of thoughts, activities, and emotions associated with the trauma, and (3) hyperarousal [2]. PTSD is usually a chronic disorder, with one third of patients displaying symptoms for ≥ 10 years after experiencing the traumatic event [3,4].
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