Buprenorphine for the treatment of posttraumatic stress disorder

Autor:	Darryl I. Shorter, Elizabeth P. Lake, Annette Walder, Thomas R. Kosten, Brian G. Mitchell, Coreen B. Domingo
Rok vydání:	2019
Předmět:	medicine.medical_specialty business.industry Chronic pain Medicine (miscellaneous) medicine.disease behavioral disciplines and activities κ-opioid receptor 030227 psychiatry 03 medical and health sciences Psychiatry and Mental health Clinical Psychology 0302 clinical medicine Pharmacotherapy Opioid Internal medicine Naloxone mental disorders medicine Anxiety Opiate medicine.symptom business 030217 neurology & neurosurgery medicine.drug Buprenorphine
Zdroj:	The American Journal on Addictions. 28:86-91
ISSN:	1055-0496
Popis:	BACKGROUND AND OBJECTIVES The core pharmacological treatment of Post-Traumatic Stress Disorder (PTSD) is selective serotonin reuptake inhibitors (SSRIs), although remission is only around 30% with them. Many patients will self-treat with opioids and due to the opiate system involvement in dysphoric mood and anxiety/stress responses, it is likely that antagonism of the kappa opioid receptor (KOR) system represents a potential target for treatment of PTSD. The aim of this study is to compare response of PTSD symptoms when antagonizing KOR via buprenorphine/naloxone compared to SSRIs or opioid therapy. METHODS A retrospective chart review of patients in the MEDVAMC between June 1, 2010 and June 30, 2016 was conducted. Inclusion criteria included patients with a documented diagnosis of PTSD with at least two documented PTSD scores (either PCLC or PC-PTSD). Exclusion criteria included patients not prescribed one of the study medications (ie, buprenorphine, SSRI, or opiate for chronic pain), and patients not on the study medication for at least 30 days. RESULTS Buprenorphine patients exhibited the lowest final average PTSD score (2.47) and the largest change from baseline (-24.0%) compared to opioids (-16.1%) or SSRIs (1.16%). The average buprenorphine dose was 23.3 mg/day, and the average length of therapy was 860 days. CONCLUSIONS Buprenorphine may help decrease PTSD symptoms more than SSRIs or opioids alone. Prospective studies are needed to determine whether these effects are reproducible. SCIENTIFIC SIGNIFICANCE Pharmacotherapy advancements in PTSD treatment have been limited and the kappa opioid receptor system presents a new target that warrants further research. (Am J Addict 2019;XX:1-6).
Databáze:	OpenAIRE
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