Suchergebnisse

OBJECTIVE: Current pharmacologic treatments for posttraumatic stress disorder (PTSD) have shown limited efficacy, prompting a call to investigate new classes of medications. The current study investigated the efficacy of glutamate modulation with riluzole augmentation for SSRI/SNRI-resistant, combat-related PTSD symptoms. METHODS: A randomized, double-blind, placebo-controlled, parallel trial was conducted at Walter Reed National Military Medical Center and Syracuse VA Medical Center between December 2013 and November 2017. Veterans and active duty service members with combat-related PTSD who were not responsive to SSRI or SNRI pharmacotherapy were randomized to 8-week augmentation with a starting dose of 100 mg/day of riluzole (n = 36) or placebo (n = 38) and assessed weekly for symptoms of PTSD, anxiety, depression, disability, and side effects. RESULTS: Intent-to-treat analyses (N = 74) of the primary outcome (CAPS for DSM-IV) showed no significant between-group difference in change in overall PTSD symptoms (F =0.64, P = .422), with a small effect size (d = .25). There was clinically significant within-group improvement in overall PTSD symptoms in both groups, with a greater mean decrease in the riluzole group (−21.1, SD = 18.9) than in the placebo group (−16.7, SD = 17.2). Exploratory analyses of PTSD symptom clusters showed significantly greater improvement on hyperarousal symptoms in the riluzole group as measured by the PTSD Checklist-Specific-Subscale D (d = 0.48) and near-significant findings on the CAPS-Subscale D. Riluzole augmentation was not superior to placebo on change in depression, anxiety, or disability severity. CONCLUSIONS: Although preliminary, the exploratory findings of this study offer some evidence that riluzole augmentation of an SSRI or SNRI may selectively improve PTSD hyperarousal symptoms without changes in overall PTSD symptoms, depression, anxiety, or disability. Additional investigation of the mechanism of riluzole's efficacy for hyperarousal symptoms is warranted.