Levetiracetam for Treatment-Refractory Posttraumatic Stress Disorder

Gustavo Kinrys, M.D.; Lisa E. Wygant, B.A.; Tamara B. Pardo, A.B.; and Maria Melo, B.A.

Objective: To assess the use of levetiracetam, a novel anticonvulsant agent, in the treatment of refractory posttraumatic stress disorder (PTSD).

Method: Retrospective analysis was conducted of 23 patients with DSM-IV diagnosis of PTSD who, after being deemed partial or nonresponders to antidepressant therapy, received levetiracetam in a naturalistic fashion. The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). Secondary outcome measures included the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impressions-Severity of Illness scale (CGI-S), and Clinical Global Impressions-Improvement scale (CGI-I).

Results: Levetiracetam at a mean ± SD dose of 1967 ± 650 mg/day for 9.7 ± 3.7 weeks was generally well tolerated. Nineteen patients (83%) were taking at least 1 concomitant medication. Patients were severely ill with a mean baseline PCL-C score of 67.2 ± 9.4, CGI-S score of 6.0 ± 0.7, and HAM-A score of 26.8 ± 4.9. Patients improved significantly on all measures (p < .001). Thirteen patients (56%) met responder criteria at endpoint (PCL-C mean change = 23.5, CGI-I score < = 2), and 6 (26%) met remission criteria (CGI-S score < = 2). Adverse events were generally mild, and no patients discontinued levetiracetam because of side effects.

Conclusion: These preliminary data suggest that levetiracetam may be an effective treatment in combination with antidepressant therapy for patients with PTSD who remain symptomatic after initial intervention.

(J Clin Psychiatry 2006;67:211-214)

Received Sept. 7, 2004; accepted July 6, 2005. From the Anxiety Disorders Research Program, Cambridge Health Alliance, Cambridge, and the Department of Psychiatry, Harvard Medical School, Boston, Mass.

Supported in part by an unrestricted educational grant from UCB Pharma, Smyrna, Ga.

Previously presented at the 24th Congress of the Collegium Internationale Neuro-Psychopharmacologicum (CINP), Paris, France, June 20-24, 2004.

Dr. Kinrys has received grant/research support and honoraria from UCB Pharma. Mss. Wygant, Pardo, and Melo report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Gustavo Kinrys, M.D., Cambridge Health Alliance-Harvard Medical School, Department of Psychiatry, 1493 Cambridge St., Cambridge, MA 02139 (e-mail: gkinrys@challiance.org).