Not all patients with PTSD respond to first-line antidepressant treatment, and current VA/Department of Defense guidelines recommend quetiapine and other antipsychotic medications as adjunctive treatments. Researchers from several VA centers and research institutions sought to determine the efficacy of quetiapine as monotherapy.
Eighty veterans meeting criteria for chronic PTSD were randomly assigned to treatment with either quetiapine or placebo tablets for 12 weeks. Quetiapine was initiated at a dose of 25 mg at bedtime and gradually titrated up to a minimum of 50 mg and maximum of 800 mg daily. The participants were evaluated at weeks 1, 2, 4, 8, and 12.
The primary outcome measure was the total Clinician-Administered PTSD Scale (CAPS) score. Secondary efficacy measures included the CAPS subscales, the Davidson Trauma Scale, the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scales for severity of illness and improvement, the Hamilton Depression Rating Scale (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A).
Patients in the quetiapine group experienced greater reductions in CAPS total, re-experiencing, and hyperarousal scores than those in the placebo group. (Scores on the CAPS avoidance/numbing subscale and the PANSS negative symptom subscale did not differ from those of the placebo group—a finding that is consistent with previous reviews of antipsychotics in the treatment of PTSD.) Patients taking quetiapine also experienced greater improvements in scores on the David Trauma Scale, CGI severity and improvement ratings, HAM-A, HAM-D, and PANSS positive symptom and general psychopathology subscale scores compared with the placebo group.
“Our findings suggest that quetiapine as a single agent is effective in the treatment of PTSD and associated depression and anxiety symptoms,” they wrote. “The level of improvement observed with quetiapine suggests it may be superior for the treatment of PTSD over other antipsychotics, such as risperidone, which did not improve global PTSD symptoms in a large study with veterans.”
For related information, see the Psychiatric News article “Military Turns to Collaborative Care to Treat PTSD, Depression” and the Psychiatric Services article “Development and Validation of a Computerized-Adaptive Test for PTSD (P-CAT).”
(Image: iStock/Todd Headington)