Topiramate was effective in improving reexperiencing and avoidance/numbing symptom clusters in patients with PTSD. This study supports the use of anticonvulsants for the improvement of symptoms of PTSD.

The new issue of CNS Neuroscience & Therapeutics includes an article: “A Double-Blind Randomized Controlled Trial To Study the Efficacy of Topiramate in a Civilian Sample of PTSD.”

The authors are Mary S. L. Yeh, Jair Jesus Mari, Mariana Caddrobi Pupo Costa, Sergio Baxter Andreoli, Rodrigo Affonseca Bressan, & Marcelo Feijó Mello.

Method: We conducted a 12-week double-blind, randomized, placebo-controlled study comparing topiramate to placebo. Men and women aged 18 – 62 years with diagnosis of PTSD according to DSM-IV were recruited … 35 patients were randomized to either group. The primary outcome measure was the CAPS total score changes.

Results: 82.35% of patients in the topiramate group exhibited improvements in PTSD symptoms. The efficacy analysis demonstrated that patients in the topiramate group exhibited significant improvements in reexperiencing symptoms: flashbacks, intrusive memories, and nightmares of the trauma (CAPS-B; P= 0.04) and in avoidance/numbing symptoms associated with the trauma, social isolation, and emotional numbing (CAPS-C; P= 0.0001). Furthermore, the experimental group demonstrated a significant difference in decrease in CAPS total score (topiramate 57.78; placebo 32.41; P= 0.0076). Mean topiramate dose was 102.94 mg/d. Topiramate was generally well tolerated.
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Comment: this is important, as psychotherapy helps many, but not all people with PTSD, and is often not available for a variety of social and economic factors.

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The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD

From the abstract for: Progress in Neuro-Psychopharmacology and Biological Psychiatry* (Volume 33, Issue 2, Pages 169-180) includes an article: “Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review.”

By William Bergera, Mauro V. Mendlowicza, Carla Marques-Portellaa, Gustavo Kinrysc, Leonardo F. Fontenellea, Charles R. Marmard, & Ivan Figueiraa,.

Can Acetaminophen Ease Psychological Pain?

Headaches and heartaches. Broken bones and broken spirits. Hurting
bodies and hurt feelings. We often use the same words to describe
physical and mental pain. Over-the-counter pain relieving drugs have
long been used to alleviate physical pain, while a host of other
medications have been employed in the treatment of depression and
anxiety. But is it possible that a common painkiller could serve double
duty, easing not just the physical pains of sore joints and headaches,
but also the pain of social rejection? A research team led by
psychologist C. Nathan DeWall of the University of Kentucky College of
Arts and Sciences Department of Psychology has uncovered evidence
indicating that acetaminophen (the active ingredient in Tylenol) may
blunt social pain.

“The idea–that a drug designed to alleviate physical pain should reduce
the pain of social rejection–seemed simple and straightforward based on
what we know about neural overlap between social and physical pain
systems. To my surprise, I couldn’t find anyone who had ever tested this
idea,” DeWall said.
(more…)

Ginkgo Biloba May Be an Effective Tool in Treating ADHD

Although psychostimulants have been proven effective in treating certain core symptoms of ADHD, some patients find their side effects intolerable while still others continue to struggle with distractibility, restlessness and irritability.

With a growing literature supporting the effectiveness of herbal products to treat neuropsychiatric illnesses, Dr. Helmut Niederhofer conducted one of the first systematic, open label trials of ginkgo biloba in patients with ADD (aged 17 to 19; N=6). Gingko biloba extract (80 mg dose containing 9.6 mg Ginkgoflavonglycosides) was administered orally three times a day for four weeks. Patients were evaluated at baseline and one month following treatment using the 60-item Wender Utah Rating Scale.

Overall, ginkgo biloba was well tolerated. Two participants reported headache and stomachaches during the first two weeks; symptoms later disappeared for one patient and consisted of mild episodes for the other. Only minimal sedation was reported.

The study found large reductions in Wender scores for fidgeting, disruptive sounds, rigidity and anxiety. The ginkgo appeared to reduce hyperactivity; enhance frustration tolerance and affect modulation; and facilitate voluntary selective processes essential to wilful cognition and discriminant attention.

Based on these promising findings, the researcher believes ginkgo biloba could be an effective alternative and/or a helpful adjunct to psychopharmaceuticals in the treatment of ADHD.

from Psychiatric Times 28 May 09

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Note: very small sample, but then again the effects were quite large. BG.

Empty bottles: Easing clients off meds

What to know about discontinuation of psychotropic medications.

By Laurie Meyers

What is the practitioner’s role when a patient comes off medication? What should a psychologist do for a client who is experiencing significant side effects? And what about clients on multiple medications?

As the health professional who often has the most contact with a client, a psychologist may be in the best position to spot or even help prevent seriously adverse reactions to medication withdrawal-if he or she knows what to look for.

“Psychologists need to be on top of what patients are taking,” says John Sexton, PhD, one of 10 participants in the U.S. Department of Defense (DoD) 1991-1997 pilot program to grant psychologists prescriptive authority. “It’s important for us to know what is going into a person’s body.”

Discontinuation dilemmas

A particular red flag to watch for: It’s all too common for patients to abruptly stop taking medication on their own, which can have unpleasant or dangerous consequences, says Sexton, who is now working in psychological and counseling services at the University of California at San Diego.

Patients may not discuss discontinuing medication with the physician who prescribed the medication, or they may not pay attention to the tapering directions they are given, points out psychologist Michael Enright, PhD, APRN, who works in a primary-care clinic in Wyoming and can prescribe because he holds a nurse-practitioner’s license. So, it’s important for practitioners to consult with the prescribing physician when possible, to get information such as the original drug dosage and how long tapering should continue, he adds. Psychologists should also be aware of the following side effects associated with particular classes of psychotropic drugs:

• Antidepressants-Due to the short time they stay in the body, some selective serotonin reuptake inhibitors (SSRIs)-a class that includes drugs such as Zoloft, Prozac, Paxil and Lexapro-can cause a discontinuation syndrome with symptoms including nausea, headache, problems sleeping, tingling or shock-like sensations, and, in some cases, flu-like symptoms. Paxil and Effexor-which is actually a serotonin-norepinephrine reuptake inhibitor-are the most likely to cause the syndrome and Prozac is the least likely, Enright notes. These reactions can be uncomfortable, but are not generally life threatening, he says.

(more…)

The front page of this morning’s *Washington Times* includes an article:
“Debate Over Drugs For ADHD Reignites; Long-Term Benefit For Children at
Issue” by Shankar Vedantam.

Here are some excerpts:

[begin excerpts]

New data from a large federal study have reignited a debate over the
effectiveness of long-term drug treatment of children with hyperactivity
or attention-deficit disorder, and have drawn accusations that some
members of the research team have sought to play down evidence that
medications do little good beyond 24 months.

The study also indicated that long-term use of the drugs can stunt
children’s growth.

The latest data paint a very different picture than the study’s positive
initial results, reported in 1999.

One principal scientist in the study, psychologist William Pelham, said
that the most obvious interpretation of the data is that the medications
are useful in the short term but ineffective over longer periods but
added that his colleagues had repeatedly sought to explain away evidence
that challenged the long-term usefulness of medication.

When their explanations failed to hold up, they reached for new ones,
Pelham said.

“The stance the group took in the first paper was so strong that the
people are embarrassed to say they were wrong and we led the whole field
astray,” said Pelham, of the State University of New York at Buffalo.

Pelham said the drugs, including Adderall and Concerta, are among the
medications most frequently prescribed for American children, adding:
“If 5 percent of families in the country are giving a medication to
their children, and they don’t realize it does not have long-term
benefits but might have long-term risks, why should they not be told?”

The disagreement has produced a range of views among the researchers
about how to accurately present the results to the public.

<snip>

In August 2007, the MTA researchers reported the first follow-up data,
which by then no longer showed differences in behavior between children
who were medicated and those who were not.

But the data did show that children who took the drugs for 36 months
were about an inch shorter and six pounds lighter than those who did not.

A news release issued by the National Institute of Mental Health (NIMH)
at the time, however, presented the results in a more favorable light.

The release, dated July 20, 2007, was titled “Improvement Following ADHD
Treatment Sustained in Most Children.”

<snip>

The release noted that the initial advantages of drug treatment were no
longer evident, but it quoted Jensen as saying this did not mean that
long-term drug therapy was ineffective.

Jensen said, “We were struck by the remarkable improvement in symptoms
and functioning across all treatment groups.”

And rather than saying the growth of children on medication was stunted,
the release said children who were not on medication “grew somewhat larger.”

<snip>

Pelham, who has conducted many drug therapy studies, said the drugs have
a valuable role: They buy parents and clinicians time to teach
youngsters behavioral strategies to combat inattention and
hyperactivity. Over the long term, he said, parents need to rely on
those skills.

A yet-to-be-published study, Pelham added, found that 95 percent of
parents who were told by clinicians to first try behavioral
interventions for ADHD did so.

When parents were given a prescription for a drug and then told to
enroll their children in behavioral intervention programs, 75 percent
did not seek out the behavioral approaches.

[end excerpts]

Courtesy of Ken Pope

The article is online at:
<http://tinyurl.com/d62thb&gt;

Taper off Effexor XR to minimize withdrawal symptoms
Joe Graedon, Teresa Graedon, The People’s Pharmacy
March 23, 2009

Patient: “I have been on Effexor XR for the last seven years for depression. I decided to wean myself off it, since it wasn’t a good mix with another drug.

The third day I was completely off Effexor, my head started spinning. I felt as if I were on a Tilt-A-Whirl. After two days of this, I ended up in the ER getting CT scans and MRIs of my brain. The doctors decided all this was from Effexor withdrawal. They gave me one tablet, and the spinning stopped within an hour.”

Pharmacist: “The whirling sensation you experienced also has been described as “head in a blender.” When people suddenly stop taking antidepressants like Celexa (citalopram), Cymbalta (duloxetine), Effexor (venlafaxine), Paxil (paroxetine) or Zoloft (sertraline) they may experience dizziness, nausea, sweating, insomnia, headaches, nervousness and electrical shock-like sensations.

Gradual tapering of the dose over several months may be the best way to minimize the unpleasant symptoms of withdrawal. Careful medical supervision is essential.”