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It Is Time to Address the Crisis in the Pharmacotherapy of Posttraumatic Stress Disorder: A Consensus Statement of the PTSD Psychopharmacology Working Group

  • John H. Krystal
    Correspondence
    Address correspondence to John H. Krystal, M.D., Yale University School of Medicine, 300 George St #901, New Haven, CT 06510; .
    Affiliations
    Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven

    Clinical Neuroscience Division, National Center for PTSD, West Haven, Connecticut

    Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut
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  • Lori L. Davis
    Affiliations
    Development Service, Tuscaloosa VA Medical Center, Tuscaloosa

    Department of Psychiatry, University of Alabama School of Medicine, Birmingham, Alabama
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  • Thomas C. Neylan
    Affiliations
    Department of Psychiatry, University of California, San Francisco

    San Francisco VA Medical Center, San Francisco
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  • Murray A. Raskind
    Affiliations
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington

    VA Puget Sound Health Care System, Seattle, Washington
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  • Paula P. Schnurr
    Affiliations
    Executive Division, National Center for PTSD, White River Junction, Vermont

    Department of Psychiatry, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
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  • Murray B. Stein
    Affiliations
    Departments of Psychiatry and Family Medicine & Public Health, University of California, San Diego, La Jolla

    VA San Diego Healthcare System, San Diego, California
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  • Jennifer Vessicchio
    Affiliations
    Clinical Neuroscience Division, National Center for PTSD, West Haven, Connecticut

    Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut
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  • Brian Shiner
    Affiliations
    Executive Division, National Center for PTSD, White River Junction, Vermont

    Department of Psychiatry, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
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  • Theresa D. Gleason
    Affiliations
    Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven
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  • Grant D. Huang
    Affiliations
    Department of Veterans Affairs, Office of Research & Development, Washington, DC

    Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC
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      There is an urgent need to address a critical lack of advancement in the psychopharmacologic treatment of posttraumatic stress disorder (PTSD). The clinical, social, and financial burden of ineffectively treated PTSD is enormous (
      • Fang S.C.
      • Schnurr P.P.
      • Kulish A.L.
      • Holowka D.W.
      • Marx B.P.
      • Keane T.M.
      • et al.
      Psychosocial functioning and health-related quality of life associated with posttraumatic stress disorder in male and female Iraq and Afghanistan war veterans: The VALOR registry.
      ,
      • Goldberg J.
      • Magruder K.M.
      • Forsberg C.W.
      • Kazis L.E.
      • Ustun T.B.
      • Friedman M.J.
      • et al.
      The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era veteran twins).
      ,
      • Sherbourne C.D.
      • Sullivan G.
      • Craske M.G.
      • Roy-Byrne P.
      • Golinelli D.
      • Rose R.D.
      • et al.
      Functioning and disability levels in primary care out-patients with one or more anxiety disorders.
      ,
      • Marmar C.R.
      • Schlenger W.
      • Henn-Haase C.
      • Qian M.
      • Purchia E.
      • Li M.
      • et al.
      Course of posttraumatic stress disorder 40 years after the Vietnam War: Findings from the National Vietnam Veterans Longitudinal Study.
      ,
      • Nock M.K.
      • Stein M.B.
      • Heeringa S.G.
      • Ursano R.J.
      • Colpe L.J.
      • Fullerton C.S.
      • et al.
      Prevalence and correlates of suicidal behavior among soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
      ,
      • Thomas J.L.
      • Wilk J.E.
      • Riviere L.A.
      • McGurk D.
      • Castro C.A.
      • Hoge C.W.
      Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.
      ). The impact of PTSD morbidity and mortality is further magnified by its substantial disruptions in family, workplace, and societal contexts (
      • Schnurr P.P.
      • Lunney C.A.
      • Bovin M.J.
      • Marx B.P.
      Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan.
      ). For the Department of Veterans Affairs (VA) and Department of Defense (DoD), i.e., institutions that are vehicles for the expression of the national debt to military personnel who developed PTSD as a consequence of their military service, the need to help these people has taken on significant priority. One in 10 VA healthcare users have the diagnosis of PTSD, which includes one in four treatment-seeking veterans of the recent wars in Iraq and Afghanistan (
      • Kessler R.C.
      • Sonnega A.
      • Bromet E.
      • Hughes M.
      • Nelson C.B.
      Posttraumatic stress disorder in the National Comorbidity Survey.
      ). The prevalence of PTSD in the general population for lifetime is approximately 8% (
      • Kessler R.C.
      • Sonnega A.
      • Bromet E.
      • Hughes M.
      • Nelson C.B.
      Posttraumatic stress disorder in the National Comorbidity Survey.
      ) and just under 4% for the current year, making it the fifth most prevalent mental disorder in the United States (
      • Perkonigg A.
      • Kessler R.C.
      • Storz S.
      • Wittchen H.U.
      Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity.
      ,
      • Helzer J.E.
      • Robins L.N.
      • McEvoy L.
      Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey.
      ,
      • Atwoli L.
      • Stein D.J.
      • Koenen K.C.
      • McLaughlin K.A.
      Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences.
      ). Despite this high prevalence and costly impact, there seems to be no visible horizon for advancements in medications that treat symptoms or enhance outcomes in persons with a diagnosis of PTSD.
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      References

        • Fang S.C.
        • Schnurr P.P.
        • Kulish A.L.
        • Holowka D.W.
        • Marx B.P.
        • Keane T.M.
        • et al.
        Psychosocial functioning and health-related quality of life associated with posttraumatic stress disorder in male and female Iraq and Afghanistan war veterans: The VALOR registry.
        J Womens Health. 2015; 24: 1038-1046
        • Goldberg J.
        • Magruder K.M.
        • Forsberg C.W.
        • Kazis L.E.
        • Ustun T.B.
        • Friedman M.J.
        • et al.
        The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era veteran twins).
        Qual Life Res. 2014; 23: 1579-1591
        • Sherbourne C.D.
        • Sullivan G.
        • Craske M.G.
        • Roy-Byrne P.
        • Golinelli D.
        • Rose R.D.
        • et al.
        Functioning and disability levels in primary care out-patients with one or more anxiety disorders.
        Psychol Med. 2010; 40: 2059-2068
        • Marmar C.R.
        • Schlenger W.
        • Henn-Haase C.
        • Qian M.
        • Purchia E.
        • Li M.
        • et al.
        Course of posttraumatic stress disorder 40 years after the Vietnam War: Findings from the National Vietnam Veterans Longitudinal Study.
        JAMA Psychiatry. 2015; 72: 875-881
        • Nock M.K.
        • Stein M.B.
        • Heeringa S.G.
        • Ursano R.J.
        • Colpe L.J.
        • Fullerton C.S.
        • et al.
        Prevalence and correlates of suicidal behavior among soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
        JAMA Psychiatry. 2014; 71: 514-522
        • Thomas J.L.
        • Wilk J.E.
        • Riviere L.A.
        • McGurk D.
        • Castro C.A.
        • Hoge C.W.
        Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.
        Arch Gen Psychiatry. 2010; 67: 614-623
        • Schnurr P.P.
        • Lunney C.A.
        • Bovin M.J.
        • Marx B.P.
        Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan.
        Clin Psychol Rev. 2009; 29: 727-735
        • Kessler R.C.
        • Sonnega A.
        • Bromet E.
        • Hughes M.
        • Nelson C.B.
        Posttraumatic stress disorder in the National Comorbidity Survey.
        Arch Gen Psychiatry. 1995; 52: 1048-1060
        • Perkonigg A.
        • Kessler R.C.
        • Storz S.
        • Wittchen H.U.
        Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity.
        Acta Psychiatr Scand. 2000; 101: 46-59
        • Helzer J.E.
        • Robins L.N.
        • McEvoy L.
        Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey.
        N Engl J Med. 1987; 317: 1630-1634
        • Atwoli L.
        • Stein D.J.
        • Koenen K.C.
        • McLaughlin K.A.
        Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences.
        Curr Opin Psychiatry. 2015; 28: 307-311
        • Nemeroff C.B.
        • Owens M.J.
        Pharmacologic differences among the SSRIs: Focus on monoamine transporters and the HPA axis.
        CNS Spectr. 2004; 9: 23-31
        • Friedman M.J.
        • Marmar C.R.
        • Baker D.G.
        • Sikes C.R.
        • Farfel G.M.
        Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting.
        J Clin Psychiatry. 2007; 68: 711-720
        • Bowers M.E.
        • Ressler K.J.
        An overview of translationally informed treatments for posttraumatic stress disorder: Animal models of Pavlovian fear conditioning to human clinical trials.
        Biol Psychiatry. 2015; 78: E15-E27
        • Risbrough V.B.
        • Glenn D.E.
        • Baker D.G.
        On the road to translation for PTSD treatment: Theoretical and practical considerations of the use of human models of conditioned fear for drug development.
        Curr Top Behav Neurosci. 2016; 28: 173-196
        • van der Kolk B.
        • Greenberg M.
        • Boyd H.
        • Krystal J.
        Inescapable shock, neurotransmitters, and addiction to trauma: Toward a psychobiology of post traumatic stress.
        Biol Psychiatry. 1985; 20: 314-325
        • Pitman R.K.
        • Rasmusson A.M.
        • Koenen K.C.
        • Shin L.M.
        • Orr S.P.
        • Gilbertson M.W.
        • et al.
        Biological studies of post-traumatic stress disorder.
        Nat Rev Neurosci. 2012; 13: 769-787
        • Smoller J.W.
        The genetics of stress-related disorders: PTSD, depression, and anxiety disorders.
        Neuropsychopharmacology. 2016; 41: 297-319
        • Logue M.W.
        • Amstadter A.B.
        • Baker D.G.
        • Duncan L.
        • Koenen K.C.
        • Liberzon I.
        • et al.
        The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: Posttraumatic stress disorder enters the age of large-scale genomic collaboration.
        Neuropsychopharmacology. 2015; 40: 2287-2297
        • Zannas A.S.
        • Provencal N.
        • Binder E.B.
        Epigenetics of posttraumatic stress disorder: Current evidence, challenges, and future directions.
        Biol Psychiatry. 2015; 78: 327-335
        • Flandreau E.I.
        • Toth M.
        Animal models of PTSD: A critical review [published online ahead of print Jan 10].
        Curr Top Behav Neurosci. 2017;
        • Licznerski P.
        • Duric V.
        • Banasr M.
        • Alavian K.N.
        • Ota K.T.
        • Kang H.J.
        • et al.
        Decreased SGK1 expression and function contributes to behavioral deficits induced by traumatic stress.
        PLoS Biol. 2015; 13: e1002282
        • Im J.J.
        • Namgung E.
        • Choi Y.
        • Kim J.Y.
        • Rhie S.J.
        • Yoon S.
        Molecular neuroimaging in posttraumatic stress disorder.
        Exp Neurobiol. 2016; 25: 277-295
        • O׳Doherty D.C.
        • Chitty K.M.
        • Saddiqui S.
        • Bennett M.R.
        • Lagopoulos J.
        A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder.
        Psychiatry Res. 2015; 232: 1-33
        • Hayes J.P.
        • Vanelzakker M.B.
        • Shin L.M.
        Emotion and cognition interactions in PTSD: A review of neurocognitive and neuroimaging studies.
        Front Integr Neurosci. 2012; 6: 89
        • Davis M.
        • Ressler K.
        • Rothbaum B.O.
        • Richardson R.
        Effects of D-cycloserine on extinction: Translation from preclinical to clinical work.
        Biol Psychiatry. 2006; 60: 369-375
        • Frank J.B.
        • Kosten T.R.
        • Giller Jr., E.L.
        • Dan E.
        A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder.
        Am J Psychiatry. 1988; 145: 1289-1291
        • Brady K.
        • Pearlstein T.
        • Asnis G.M.
        • Baker D.
        • Rothbaum B.
        • Sikes C.R.
        • et al.
        Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial.
        JAMA. 2000; 283: 1837-1844
        • Davidson J.R.
        • Rothbaum B.O.
        • van der Kolk B.A.
        • Sikes C.R.
        • Farfel G.M.
        Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder.
        Arch Gen Psychiatry. 2001; 58: 485-492
        • Tucker P.
        • Zaninelli R.
        • Yehuda R.
        • Ruggiero L.
        • Dillingham K.
        • Pitts C.D.
        Paroxetine in the treatment of chronic posttraumatic stress disorder: Results of a placebo-controlled, flexible-dosage trial.
        J Clin Psychiatry. 2001; 62: 860-868
        • Marshall R.D.
        • Beebe K.L.
        • Oldham M.
        • Zaninelli R.
        Efficacy and safety of paroxetine treatment for chronic PTSD: A fixed-dose, placebo-controlled study.
        Am J Psychiatry. 2001; 158: 1982-1988
        • Lee D.J.
        • Schnitzlein C.W.
        • Wolf J.P.
        • Vythilingam M.
        • Rasmusson A.M.
        • Hoge C.W.
        Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: Systemic review and meta-analyses to determine first-line treatments.
        Depress Anxiety. 2016; 33: 792-806
        • Institute of Medicine of the National Acadmies
        Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence.
        The National Academies Press, Washington, DC2007
        • Northeast Program Evaluation Center
        Prescriptions among Veterans with a PTSD diagnosis—Data abstracted from VA Administrative records, June 2016.
        VA Office of Mental Health Operations, Washington, DC2016
        • Bernardy N.C.
        • Lund B.C.
        • Alexander B.
        • Friedman M.J.
        Prescribing trends in veterans with posttraumatic stress disorder.
        J Clin Psychiatry. 2012; 73: 297-303
        • Krystal J.H.
        • Rosenheck R.A.
        • Cramer J.A.
        • Vessicchio J.C.
        • Jones K.M.
        • Vertrees J.E.
        • et al.
        Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: A randomized trial.
        JAMA. 2011; 306: 493-502
        • Shiner B.
        • Westgate C.L
        Preliminary analysis of 1-year psychotropic medication receipt among VA patients with new episodes of PTSD care, 2004-2013.
        Ongoing VA-Funded Research. 2016; (“Improving Care for PTSD”; HSR&D CDA11-263)
        • Shiner B.
        • Westgate C.L.
        • Bernardy N.C.
        • Schnurr P.P.
        • Watts B.V.
        Anticonvulsant medication use in veterans with posttraumatic stress disorder.
        J Clin Psychiatry. 2017; 78: e545-e552
        • Harpaz-Rotem I.
        • Rosenheck R.A.
        Tracing the flow of knowledge: Geographic variability in the diffusion of prazosin use for the treatment of posttraumatic stress disorder nationally in the Department of Veterans Affairs.
        Arch Gen Psychiatry. 2009; 66: 417-421
        • Raskind M.A.
        • Peskind E.R.
        • Hoff D.J.
        • Hart K.L.
        • Holmes H.A.
        • Warren D.
        • et al.
        A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.
        Biol Psychiatry. 2007; 61: 928-934
        • Raskind M.A.
        • Peterson K.
        • Williams T.
        • Hoff D.J.
        • Hart K.
        • Holmes H.
        • et al.
        A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan.
        Am J Psychiatry. 2013; 170: 1003-1010
        • Kelmendi B.
        • Adams T.G.
        • Yarnell S.
        • Southwick S.
        • Abdallah C.G.
        • Krystal J.H.
        PTSD: From neurobiology to pharmacological treatments.
        Eur J Psychotraumatol. 2016; 7: 31858
        • Davidson J.R.
        • Brady K.
        • Mellman T.A.
        • Stein M.B.
        • Pollack M.H.
        The efficacy and tolerability of tiagabine in adult patients with post-traumatic stress disorder.
        J Clin Psychopharmacol. 2007; 27: 85-88
        • Gelpin E.
        • Bonne O.
        • Peri T.
        • Brandes D.
        • Shalev A.Y.
        Treatment of recent trauma survivors with benzodiazepines: A prospective study.
        J Clin Psychiatry. 1996; 57: 390-394
        • Guina J.
        • Rossetter S.R.
        • De R.B.
        • Nahhas R.W.
        • Welton R.S.
        Benzodiazepines for PTSD: A systematic review and meta-analysis.
        J Psychiatr Pract. 2015; 21: 281-303
        • Rothbaum B.O.
        • Price M.
        • Jovanovic T.
        • Norrholm S.D.
        • Gerardi M.
        • Dunlop B.
        • et al.
        A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans.
        Am J Psychiatry. 2014; 171: 640-648
        • Pollack M.H.
        • Hoge E.A.
        • Worthington J.J.
        • Moshier S.J.
        • Wechsler R.S.
        • Brandes M.
        • et al.
        Eszopiclone for the treatment of posttraumatic stress disorder and associated insomnia: A randomized, double-blind, placebo-controlled trial.
        J Clin Psychiatry. 2011; 72: 892-897
        • Lund B.C.
        • Bernardy N.C.
        • Alexander B.
        • Friedman M.J.
        Declining benzodiazepine use in veterans with posttraumatic stress disorder.
        J Clin Psychiatry. 2011;
        • Guina J.
        • Nahhas R.W.
        • Goldberg A.J.
        • Farnsworth S.
        PTSD symptom severities, interpersonal traumas, and benzodiazepines are associated with substance-related problems in trauma patients.
        J Clin Med. 2016; 5: E70
        • Kosten T.R.
        • Fontana A.
        • Sernyak M.J.
        • Rosenheck R.
        Benzodiazepine use in posttraumatic stress disorder among veterans with substance abuse.
        J Nerv Ment Dis. 2000; 188: 454-459
        • Bernardy N.C.
        • Lund B.C.
        • Alexander B.
        • Jenkyn A.B.
        • Schnurr P.P.
        • Friedman M.J.
        Gender differences in prescribing among veterans diagnosed with posttraumatic stress disorder.
        J Gen Intern Med. 2013; 28: S542-S548
        • Weathers F.W.
        • Keane T.M.
        • Davidson J.R.
        Clinician-administered PTSD scale: A review of the first ten years of research.
        Depress Anxiety. 2001; 13: 132-156
        • Raskind M.A.
        • Peskind E.R.
        • Kanter E.D.
        • Petrie E.C.
        • Radant A.
        • Thompson C.E.
        • et al.
        Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: A placebo-controlled study.
        Am J Psychiatry. 2003; 160: 371-373
        • van Liempt S.
        • Vermetten E.
        • Geuze E.
        • Westenberg H.G.
        Pharmacotherapy for disordered sleep in post-traumatic stress disorder: A systematic review.
        Int Clin Psychopharmacol. 2006; 21: 193-202
        • Byers M.G.
        • Allison K.M.
        • Wendel C.S.
        • Lee J.K.
        Prazosin versus quetiapine for nighttime posttraumatic stress disorder symptoms in veterans: An assessment of long-term comparative effectiveness and safety.
        J Clin Psychopharmacol. 2010; 30: 225-229
        • Raskind M.A.
        • Millard S.P.
        • Petrie E.C.
        • Peterson K.
        • Williams T.
        • Hoff D.J.
        • et al.
        Higher pretreatment blood pressure is associated with greater posttraumatic stress disorder symptom reduction in soldiers treated with prazosin.
        Biol Psychiatry. 2016; 80: 736-742
        • Davidson J.
        • Bernik M.
        • Connor K.M.
        • Friedman M.J.
        • Jobson K.O.
        • Kim Y.
        • et al.
        A new treatment algorithm for posttraumatic stress disorder.
        Pyschiatr Ann. 2005; 35: 887-900
        • Management of Post-Traumatic Stress Working Group
        VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress Disorder.
        Department of Veterans Affairs and Department of Defense, Washington, DC2010
        • Petrakis I.L.
        • Desai N.
        • Gueorguieva R.
        • Arias A.
        • O׳Brien E.
        • Jane J.S.
        • et al.
        Prazosin for veterans with posttraumatic stress disorder and comorbid alcohol dependence: A clinical trial.
        Alcohol Clin Exp Res. 2016; 40: 178-186
        • Gaynes B.N.
        • Warden D.
        • Trivedi M.H.
        • Wisniewski S.R.
        • Fava M.
        • Rush A.J.
        What did STAR*D teach us? Results from a large-scale, practical, clinical trial for patients with depression.
        Psychiatr Serv. 2009; 60: 1439-1445
        • Rush A.J.
        • Fava M.
        • Wisniewski S.R.
        • Lavori P.W.
        • Trivedi M.H.
        • Sackeim H.A.
        • et al.
        Sequenced treatment alternatives to relieve depression (STAR*D): Rationale and design.
        Control Clin Trials. 2004; 25: 119-142
        • Trivedi M.H.
        • Fava M.
        • Wisniewski S.R.
        • Thase M.E.
        • Quitkin F.
        • Warden D.
        • et al.
        Medication augmentation after the failure of SSRIs for depression.
        N Engl J Med. 2006; 354: 1243-1252
        • GSK Clinical Study Register
        A randomized, double-blind, placebo-controlled parallel-group, fixed-dose study evaluating the efficacy and safety of the neurokinin-1 receptor antagonist orvepitant (GW823296) in post traumatic stress disorder (PTSD).
        Protocol summary. 2013; (Available at: http://GSK-clinicalstudyregister.com/study/113211. Accessed February 20, 2017)
        • Sullivan G.
        • Gendreau J.
        • Gendreau R.M.
        • Schaberg A.
        • Daugherty B.
        • Jividen H.
        • et al.
        The AtEase study: A Phase 2 multicenter, randomized clinical trial of the safety and efficacy of TNX-102 SL in the treatment of military-related PTSD.
        Poster presented at the 55th Annual Meeting of the American College of Neuropsychopharmacology, December 7, Hollywood, Florida2016
        • Back S.E.
        • McCauley J.L.
        • Korte K.J.
        • Gros D.F.
        • Leavitt V.
        • Gray K.M.
        • et al.
        A double-blind randomized, controlled pilot trial of N-acetylcysteine in veterans with posttraumatic stress disorder and substance use disorders.
        J Clin Psychiatry. 2016; 77: e1439-e1446

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        Biological PsychiatryVol. 84Issue 2
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          In a recent letter to the editor, Krystal et al. (1) noted that “There is an urgent need to address a critical lack of advancement in the psychopharmacologic treatment of posttraumatic stress disorder (PTSD)” (1). Most medications used on- or off-label for PTSD currently belong to typical categories of psychotropic medications. Current treatments that use psychotherapy and pharmaceuticals have a low success rate in the veteran population. With only 50% of veterans seeking care and a 40% recovery rate, current strategies will effectively reach no more than 20% of all veterans who need PTSD treatment (2).
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      • Response to the Consensus Statement of the PTSD Psychopharmacology Working Group
        Biological PsychiatryVol. 84Issue 2
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          We are writing in response to the letter to the editor by Krystal et al. (1). This timely research statement pointed out some of the barriers to translating a wealth of posttraumatic stress disorder (PTSD) research into effective pharmacological strategies. The group did not review all potential agents currently being assessed for PTSD; thus, the addition of two promising candidates—cannabis and 3,4-methylenedioxymethamphetamine (MDMA)—would make this report more comprehensive. Both are under investigation in U.S.
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