From the Guidelines
Suitable Add-on Medications for PTSD
For patients with PTSD who are already on venlafaxine, a potential add-on medication could be a second-generation antipsychotic such as risperidone, starting at a low dose of 0.5-1mg at bedtime, or an alpha-1 adrenergic receptor blocker like prazosin, starting at 1-2mg at bedtime 1, 2, 3. Alternatively, an augmenting agent like topiramate, starting at 25mg at bedtime and gradually increasing to 50-100mg, could be considered.
- Key considerations for these medications include their potential to reduce nightmare frequency and improve sleep quality, as evidenced by studies on risperidone's efficacy in treating PTSD-related nightmares 3.
- Risperidone has shown moderate to high efficacy in two studies, with doses ranging from 0.5-3 mg per day, and has been associated with a significant decrease in nightmare frequency 3.
- Prazosin and topiramate are also mentioned as potential options for treating PTSD-associated nightmares, although the evidence for their use is less clear 1, 2. However, it's crucial to carefully weigh the potential benefits against the risks and monitor the patient closely for any adverse effects or interactions.
- Monitoring for side effects, such as those associated with atypical antipsychotics or alpha-1 adrenergic receptor blockers, is essential to ensure safe and effective treatment.
- Individualized treatment plans should be developed based on the patient's specific needs and circumstances, taking into account the available evidence and clinical judgment 1, 2.
From the Research
Suitable Add-on Medications for PTSD
In patients already taking Venlafaxine (Effexor) for post-traumatic stress disorder (PTSD), several medications can be considered as add-on therapies. The following options are supported by existing research:
- Prazosin: This medication has shown small statistically significant evidence for reducing PTSD symptoms when used as an augmentation therapy 4.
- Risperidone: Similar to prazosin, risperidone has demonstrated a small positive effect when used to augment pharmacological monotherapy for PTSD 4.
- Quetiapine: As a second-generation antipsychotic, quetiapine has been found to be effective in reducing PTSD symptoms, including re-experiencing, avoidance, and hyperarousal symptoms, as well as depressive and anxiety symptoms 5, 6. It is often prescribed for its sedative effects, which can be beneficial for patients with PTSD 5.
Considerations for Add-on Medications
When selecting an add-on medication for PTSD, it is essential to consider the individual patient's clinical features and comorbidities. For example:
- Patients with psychotic depression may benefit from the use of quetiapine, which has been shown to be effective in treating this condition 7.
- Patients with high levels of disability may require combined treatment with evidence-based psychotherapy, as this has been found to predict meaningful improvement in PTSD symptoms 8.
Available Research
The existing research on add-on medications for PTSD is primarily based on studies of monotherapy and augmentation strategies. While some medications, such as quetiapine, have shown promise in reducing PTSD symptoms, more research is needed to fully understand their efficacy and safety in this context 6.