Open Trial of Nefazodone for Combat-Related Posttraumatic Stress Disorder

Background: Because of its ability to block 5-HT₂ receptorspostsynaptically and inhibit 5-HT reuptake presynaptically and/or its enhancement of sleepquality, nefazodone may be useful for symptom management in posttraumatic stress disorder(PTSD) patients.

Method: Ten patients with combat-related DSM-IV posttraumatic stressdisorder (PTSD) entered an open-label 12-week trial of nefazodone with a 4-week follow-up,beginning with 100 mg/day and increasing as necessary to achieve a maximal response oruntil reaching a maximum dosage of 600 mg/day.

Results: Nefazodone was well tolerated, and no significant changes insexual function were reported. Based on Clinical Global Impressions-Improvement scores,all 10 patients were rated as much improved. All PTSD symptoms (except self-reported PTSDreexperiencing symptoms), sleep, and clinician-rated depression significantly improved atweek 12. At follow-up, significant changes were maintained, and self-reported PTSDreexperiencing symptoms had also significantly improved. Effect sizes for all changedsymptoms were moderate to large at week 12 and at follow-up. Self-reported andclinician-rated anger significantly improved. Self-reported depression failed to improve.Improvement in social and occupational functioning was minimal.

Conclusion: These preliminary data suggest that nefazodone may beeffective in reducing the 3 primary PTSD symptom clusters and may be particularly helpfulin improving sleep and decreasing anger.