Open-Label Trial of Escitalopram in the Treatment of Posttraumatic Stress Disorder
Sophie Robert, PharmD; Mark B. Hamner, MD; Helen G. Ulmer, RN, MSN; Jeffrey P. Lorberbaum, MD; and Valerie L. Durkalsk, PhD, MPH;
J Clin Psychiatry 2006;67(10):1522-1526
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Posttraumatic stress
disorder (PTSD) is a highly prevalent, disabling illness.
Selective serotonin reuptake inhibitors (SSRIs)
are considered first-line medication treatment,
with sertraline, paroxetine, and fluoxetine being the
most studied. More limited but favorable data
suggest that citalopram, an SSRI, may also have a role
in the treatment of PTSD. Its S-enantiomer
escitalopram, which may have faster onset and greater
magnitude of effect than citalopram in other
conditions, has not yet been investigated in PTSD.
Objective: To assess the efficacy, safety,
and tolerability of escitalopram in the treatment
of PTSD.
Method: A 12-week, prospective,
open-label trial of escitalopram was conducted from
January 2003 through August 2004 in military veterans
with PTSD. Escitalopram was initiated at 10 mg daily
for 4 weeks, then increased to 20 mg daily for the
remainder of the study. Concomitant psychiatric medications were discontinued at least 2
weeks prior to enrollment. The primary outcome
variable was the change from baseline to endpoint in
global Clinician-Administered PTSD Scale-Symptom
version (CAPS-SX) score. Secondary efficacy measures included the Clinical Global
Impressions-Severity of Illness (CGI-S) and
-Improvement (CGI-I) scales, the Hamilton Rating Scale for
Depression (HAM-D), and the Davidson Trauma Scale (DTS). Posttraumatic stress disorder and
comorbid diagnoses were established using the
Structured Clinical Interview for Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition.
Results: Twenty-four of 25 patients were
evaluated for efficacy. The mean global CAPS-SX
score decreased from 79.4 (SD = 15.7) at baseline to
61.2 (SD = 24.7) at the end of the study (p = .0002).
The CAPS-C avoidance/numbing and CAPS-D hyperarousal subscale scores decreased significantly
from baseline to endpoint (CAPS-C, p = .0171;
CAPS-D, p = .0001), with trend-level reductions observed
in CAPS-B reexperiencing subscale scores (p = .0593). Forty-five percent of patients (9/20)
were much or very much improved at the end of the study (CGI-I of 1 or 2). The HAM-D and DTS
also significantly improved (p = .0063 and p =
.0004, respectively). Mild to moderate gastrointestinal
disturbances were the most common side effects.
Only 4 patients discontinued early because of
adverse effects.
Conclusions: This preliminary open-label
study suggests that escitalopram is both efficacious
and well tolerated in PTSD patients. However,
randomized controlled studies are needed to confirm
these results and to further define its potential role in
the treatment of PTSD.