Abstract
Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities. The objective was to perform a pilot clinical trial designed to compare the effects of older (tricyclic) and newer "second-generation" (selective inhibitors of serotonin uptake) antidepressants in the treatment of PTSD. A total of 20 hospitalised chronic military combat Bosnian veterans with PTSD symptoms were randomly assigned into two groups of 10 patients each. One group was treated with amitriptyline hydrochloride (AMYZOL) 75 mg/day as a representative of older antidepressants and the other with fluoxetine hydrochloride 60 mg/day (OXETIN) as a representative of newer antidepressants. Those drugs were administered by mouth two or three times-a-day in equally divided doses for at least 8 weeks. Favourable response was achieved in 70% of patients treated with amitriptyline hydrochloride and 60% of patients treated with fluoxetine hydrochloride. Amitriptyline hydrochloride was more effective in the treatment of acute PTSD symptoms (emotional numbing, startle reaction, nightmares, flashbacks, intrusive thoughts, vulnerability, poor impulse control or irritability and explosiveness). Fluoxetine hydrochloride showed a greater efficacy in the treatment of chronic PTSD symptoms (avoidance and numbing symptoms, hyperarousal, nightmares and a feeling of guilt).
Highlights
IntroductionPosttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities (DSM-III, 1980)
Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress, which may be identified in cognitive, affective or sensory motor activities (DSM-III, 1980)
Since pharmacotherapy of PTSD may include the administration of antidepressant agents, the objective of this study was to perform a pilot clinical trial designed to compare the effects of the representatives of older and newer antidepressants in the treatment of PTSD
Summary
Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities (DSM-III, 1980). It has been reported that prevalence of PTSD among Vietnam veterans was approximately 67% (YEHYDA, 1999), in people experiencing natural disasters or catastrophes 30% (YEHYDA, 1999), and in women experiencing sexual abuse or sexual assault (rape) between 57% and 80% (REGEHR, 1999). Using an experimental approach, BLANCHARD et al (1982) have reported that heart rate response to audiotape of combat sounds successfully differentiated normal from PTSD patients in 95.5% of cases. In DSM-IV (1994) are described three subtypes of PTSD: Systolic blood pressure and forehead electromyographic response differed between groups.
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