Is There a Role for Second Generation Antipsychotics in the Treatment of PTSD

Posttraumatic Stress Disorder (PTSD) is common in civilians and veterans and is often chronic and disabling [1&2]. The Selective Serotonin Reuptake Inhibitors (SSRIs) and venlafaxine are considered first line treatment for PTSD although only sertraline and paroxetine have FDA approval [3]. These medications have been shown to improve most PTSD symptoms and in particular, irritability [4&5]. However, they have little effect on insomnia [4&5] which is serious problem in PTSD patients [6]. Military veterans tend to have little or no response to antidepressant medications [7-10]. Second Generation Antipsychotics (SGAs) are often used in the treatment of PTSD, particularly for insomnia [11]. A review of SGAs randomized trials in the treatment of PTSD found the most evidence of benefit from quetiapine and risperidone, particularly for re-experiencing and hyperarousal symptoms [12].