Active Ingredient: Gabapentin
The case was further complicated by the death of a surrogate parent the day of her initial interview. She was receiving no medications at the time of intake. G was started on treatment with olanzapine.
Her sleep that week improved to 8. During her third visit day 24, she indicated that her nightmares had not returned.
Because of a family history of diabetes and concerns over carbohydrate craving and recent weight gain, topiramate, 25 mg p. At the next clinic visit day 81, Ms. G indicated that she had lost 5 lb 2 kg and was feeling very much improved.
She still displayed avoidance of bathrooms a site of early abuse and significant psychic numbing. Six of 7 patients demonstrated improvement of these symptoms after failing to adequately respond to standard SSRI monotherapy.
Other beneficial olanzapine actions included rapid mood stabilization, especially in the 3 patients with diagnosed bipolar disorder. Olanzapine was generally well tolerated, with 2 patients initially discontinuing therapy due to concerns about weight gain.
Both elected to restart treatment due to recurrence of nightmares. A third patient concerned about weight gain was successfully treated with adjunctive topiramate.
Olanzapine appears to be an effective and rational adjunctive agent for treating the reexperiencing cluster of PTSD symptoms, especially sleep disturbance secondary to nightmares.
Future controlled studies are needed to better characterize and quantify this therapeutic indication. The importance of recognizing and treating chronic sleep disruption in potential PTSD patients cannot be overemphasized.
If antidepressant therapy does not adequately improve sleep or stop nightmares, then adjunctive treatment with olanzapine, topiramate, or prazosin should be considered.
Drug names: bupropion Wellbutrin and others, carbamazepine Tegretol and others, citalopram Celexa, diazepam Valium and others, divalproex sodium Depakote, fluoxetine Prozac and others, gabapentin Neurontin, lithium Eskalith, Lithobid, and others, mirtazapine Remeron, nefazodone Serzone, olanzapine Zyprexa, paroxetine Paxil, prazosin Minipress and others, quetiapine Seroquel, sertraline Zoloft, thiothixene Navane and others, topiramate Topamax, trazodone Desyrel and others, venlafaxine Effexor.
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