Treating PTSD and Major Depressive Disorder in Military Veterans

For combat veterans, posttraumatic stress disorder (PTSD) is an all too common psychiatric condition. The symptoms of PTSD include high anxiety, a heightened state of arousal, aggression, and sleep disturbances. Many with PTSD report feelings similar to combat situations, as if they never really left the battlefield. When it is accompanied by moderate or major depression, those with PTSD are notoriously unresponsive to traditional therapies and medications. Self-injurious and self-destructive behaviors, even psychotic behaviors, are not uncommon events for the most severely affected veterans. Finding new and better treatment protocols is therefore essential.

Recent research indicates that Abilify (aripiprazole), a relatively new antipsychotic medication, may represent a moderately more successful approach for treating PTSD and major depressive disorder in veterans. Study authors performed a retrospective review of veterans’ charts to determine what effect, if any, the introduction of Abilify had on these patients’ PTSD and depression scores. A total of 27 charts were analyzed. Many of these patients were also receiving traditional antidepressants, anti-anxiety medications, or psychotherapy. All consented to participate in research on the use of Abilify to manage their symptoms. Most had shown very little or no response to their prior courses of treatment.

The study consisted of a 12-week trial of Abilify, with regular monitoring for side effects or improvements in mood. The overall positive response rate, both in terms of PTSD and depression, were rather low. At the end of 12 weeks, about 20% of these veterans showed significant improvement in their depression. Likewise, 37% showed improvement in their PTSD symptoms. These are not excellent results, but historically this population has been very resistant to most clinical approaches. Any improvement over failed techniques is worthwhile, and even small improvements to quality of life are deemed worth pursuing. Furthermore, Abilify has no potential for abuse and relatively few side effects. It is much better tolerated than many of the traditional antidepressants and anti-anxiety medications.

PTSD makes readjustment to civilian life an uphill battle for many veterans. Too many find themselves in a cycle of fear, self-loathing, anger, depression, and substance abuse. Abilify, originally developed as a first-line treatment for schizophrenic patients, has shown the potential to ease the symptoms of PTSD in at least some of these veterans. More research is needed, but the outlook is promising.

References
Richardson, J.D., Fikretoglu, D., Liu, A., McIntosh, D. (2011). Aripiprazole augmentation in the treatment of military-related PTSD with major depression: a retrospective chart review. BMC Psychiatry, 11, 86.

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