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.
——————–
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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What predicts which women will develop PTSD after a potentially traumatic event?

Number of baseline PTSD reexperiencing symptoms, rape history, and history of childhood physical assault were all found to predict PTSD chronicity 2 years later.

Chronic cases were also more likely to experience subsequent exposure to potentially traumatic stressors not involving interpersonal violence.

Contrary to our prediction, binge drinking and poorer perceived health did not predict chronicity.

An analysis of mental health treatment seeking revealed no relationship between remission status and treatment seeking at baseline or any of the follow-up assessments, even when controlling for baseline PTSD symptom severity.

The absence of a relationship between subsequent treatment seeking and remission status suggests that, for many women, symptoms subsided without professional assistance.”

[Comment: That is, I would say, 1/2 got better using their own network and resources, not those of a professional; this probably does not mean that PTSD just evaporates.]

Psychological Trauma: Theory, Research, Practice, and Policy has scheduled an article for publication in a future issue: “Factors Associated With Chronicity in Posttraumatic Stress Disorder: A Prospective Analysis of a National Sample of Women.” The authors are Jesse R. Cougle, Heidi Resnick, and Dean G. Kilpatrick.

The American Academy of Sleep Medicine issued the following news release:

Bright light therapy improves sleep disturbances in soldiers with combat PTSD

Study suggests that bright light therapy may be an effective treatment
for combat-related post-traumatic stress disorder

Bright light therapy has significant effects on sleep disturbances
associated with combat-related post-traumatic stress disorder, according
to a research abstract that will be presented Monday, June 7, 2010, in
San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the
Associated Professional Sleep Societies LLC.

Results indicate that bright light therapy produced a significantly
greater improvement than placebo in sleep disturbances specific to PTSD.

Bright light therapy also produced a moderate improvement in PTSD
symptoms and depression.

“Results of this ongoing study show significant effects of bright light
on disruptive nocturnal behaviors associated with combat PTSD, as well
as positive effects of bright light therapy on PTSD symptom severity,”
said study coordinator Shannon Cornelius, PhD, graduate research
assistant for Dr. Shawn D. Youngstedt in the department of exercise
science at the University of South Carolina in Columbia, S.C.

“Because bright light therapy is a relatively simple, self-administered,
inexpensive treatment with few side effects, these results are an
important step to further establish the efficacy of bright light therapy
as an alternative or adjunct treatment for combat-related PTSD.”

The study involved 16 soldiers who returned to the U.S. with combat-
related PTSD after serving in Operation Enduring Freedom or Operation
Iraqi Freedom. Following a one-week baseline, participants were
randomized to one of two four-week treatments.

Eight soldiers received 10,000 lux of bright light therapy for 30
minutes each day. The other eight participants were assigned to the
placebo group and received sham treatment with an inactivated negative
ion generator.

The Clinician-Administered PTSD Scale (CAPS-2) was completed at
baseline and immediately following completion of the study.

At weekly intervals, depression was assessed with the Beck Depression
Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh
Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem
that can play both a precipitating and perpetuating role in PTSD, making
it an important target for therapy.

“Disturbed sleep is known to interact with depression and anxiety in a
vicious cycle,” said Cornelius.

“By reducing the severity and occurrence of sleep disturbances, it may
be possible to reduce the severity of symptoms such as anxiety and
depression in combat-related PTSD.”

The American Academy of Sleep Medicine reports that 70 to 90 percent of
people with PTSD describe subjective sleep disturbance. Recurrent
nightmares of the traumatic event represent one of the most problematic
and enduring symptoms of PTSD.

These nightmares may take the form of a realistic reliving of the
traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of
light for a specific and regular length of time.

Typically it involves exposure to up to 10,000 lux of light for
scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt
reported that bright light exposure may have an anxiolytic effect.

Three hours of exposure to 3,000 lux of bright light for three
consecutive days reduced anxiety in a group of low-anxiety adults.

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,.

Adults who suffer migraine headaches are more apt to have post-traumatic stress disorder (PTSD) than the general population, a new study suggests. And having PTSD and migraine may lead to greater headache-related disability.

Excerpts follow:

<snip>

Among a group of 593 adults with migraine, PTSD was present in roughly 30 percent of those who suffered chronic daily headaches and about 22 percent of those with “episodic” migraine headaches. By comparison, approximately 8 percent of the population is estimated to have PTSD.

<snip>

“The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine,” Peterlin said, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD.

<snip>

SOURCE: Headache April 2009.
The full article can be found at
http://www.canada.com/news/Post+traumatic+stress+common+migraine+sufferers/1461579/story.html

June’s *British Journal of Psychiatry* (vol. 194, #6) includes an
article: “Delayed-onset post-traumatic stress disorder among war
veterans in primary care clinics.”

The authors are B. Christopher Frueh, Anouk L. Grubaugh, Derik E.
Yeager, & Kathryn M. Magruder.

Here’s the abstract:

Background

Only limited empirical data support the existence of delayed-onset post-
traumatic stress disorder (PTSD).

Aims

To expand our understanding of delayed-onset PTSD prevalence and
phenomenology.

Method

A cross-sectional, epidemiological design (n = 747) incorporating
structured interviews to obtain relevant information for analyses in a
multisite study of military veterans.

Results

A small percentage of veterans with identified current PTSD (8.3%,
7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only
(5.4%, 2/37) met criteria for delayed onset with PTSD symptoms
initiating more than 6 months after the index trauma. Altogether only
0.4% (3/747) of the entire sample had current PTSD with delayed-onset
symptoms developing more than 1 year after trauma exposure, and no PTSD
symptom onset was reported more than 6 years post-trauma.

Conclusions

Retrospective reports of veterans reveal that delayed-onset PTSD
(current, subthreshold or lifetime) is extremely rare 1 year post-
trauma, and there was no evidence of PTSD symptom onset 6 or more years
after trauma exposure.

Courtesy of Ken Pope

Today’s new issue of *Journal of the American Medical Association* (Vol.
301 No. 13, April 1, 2009) includes an article: “Abuse and the Brain” by
Joan Stephenson, PhD.

Here’s how the article begins:

[begin excerpt]

Early childhood abuse might exert lifelong effects by altering a
person’s DNA and reducing levels of glucocorticoid receptors in the
brain, which are important for responding to stress, Canadian scientists
have found (McGowan PO et al. Nat Neurosci. 2009;12[3]:342-348).

The investigators examined brain tissue from 24 men who had committed
suicide, half of whom had a history of childhood abuse, and from 12 men
who had not been abused and died suddenly from other causes.

Men with a history of abuse had lower levels of glucocorticoid receptors
than did men who had not been abused or had not committed suicide.

In addition, in those who had been abused, a snippet of “promoter” DNA
that normally facilitates the production of glucocorticoid receptors had
been silenced by the attachment of a methyl group.

The researchers noted the work confirms their previous findings…

[end excerpt]

The article is online — but requires a subscription — at:
<http://tinyurl.com/comoql&gt;.

Courtesy of Ken Pope