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Powerful Antidepressant to Tackle Trauma Condition

National trial will pit Effexor against post traumatic stress disorder

WEDNESDAY, Feb. 27, 2002 (HealthDayNews) -- Researchers are launching a national study to determine if a powerful antidepressant will help people suffering from post traumatic stress disorder, a harrowing condition that stubbornly resists drug treatment.

Effexor, a sibling of the well-known antidepressant Prozac, may give doctors the weapon they need against post-traumatic stress disorder (PTSD), says Dr. David M. Goldstein, who is overseeing a part of the clinical trial at Georgetown University Medical Center.

Currently, "we don't have a treatment that's anywhere near as good as those for other psychiatric conditions," he says.

PTSD has been a part of the formal vocabulary of psychology for only about 20 years, but its effects have long been known among people who survive traumatic events like war, accidents and violence. Sufferers report a variety of symptoms, including flashbacks, depression, anxiety, emotional numbness and panic attacks.

In many cases, sufferers feel constantly on alert, an obsessive sense of vigilance that can rob people of sleep and sabotage their personal relationships.

The federal government has approved two antidepressants, Paxil and Zoloft, for the treatment of PTSD. Both drugs are in the same class as Prozac, which is not as popular as a treatment for PTSD because it sometimes raises anxiety levels, Goldstein explains.

But neither Paxil nor Zoloft has a high success rate at easing PTSD, Goldstein says.

"The level of efficacy is mild to moderate," he says. "They were approved probably because there's nothing else that was really demonstrated to be that effective."

By contrast, he says, "we have very good treatments for depression that (alleviate) symptoms probably 70 percent of the time. And you can stop panic attacks 80 percent of the time."

In addition to antidepressants, doctors treat PTSD with a variety of psychiatric drugs, including anti-convulsants and tranquilizers.

As part of a 15-week nationwide trial funded by Wyeth Ayerst -- the maker of Effexor -- which will involve 500 people, Georgetown University is recruiting 10 to 20 PTSD sufferers to see if the drug reduces their symptoms. Some will receive doses of Effexor, while others will get Zoloft or a placebo.

Doctors can already prescribe Effexor for PTSD, although it is not officially approved for that use. Doctors report the success rate of Effexor appears to be higher than the usual 50 percent when other drugs are used, Goldstein says. The drug increases levels of the brain chemicals serotonin and norepinephrine, while Zoloft and other antidepressants only raise the levels of serotonin in the brain.

Effexor is currently approved for the treatment of depression and anxiety.

Even when drug treatment is successful, it doesn't make PTSD disappear, says Esther Giller, director of the Sidran Traumatic Stress Institute in Baltimore.

"The symptoms of PSTD are so disruptive, intrusive and problematic for people that very often they can't attend to the issues of therapy without something to lessen those symptoms," she says. "(Drug treatment) is a first line of attack, but it's really not a cure. It's a management tool."

Some people resist the idea of medication, and must find alternative ways to reduce their levels of physical and mental stress, she says. "There are non-pharmaceutical techniques to control, manage and learn to live with those various symptoms."

What To Do

Learn more about PTSD from the Sidran Traumatic Stress Institute.

You can also learn more from the National Center for PTSD.

SOURCES: Interviews with Dr. David M. Goldstein, M.D., director, mood and anxiety disorders program, Georgetown University Medical Center, Washington, D.C.; Esther Giller, M.A., director, Sidran Traumatic Stress Institute, Baltimore
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