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Some Symptoms Respond Earlier Than Others in PTSD Patients Treated With Venlafaxine XR: Presented at APA

By Kristina R. Anderson

SAN DIEGO, CA -- May 24, 2007 -- Previous studies have shown that venlafaxine extended release improves symptoms of posttraumatic stress disorder (PTSD) and depression, but now evidence suggests that some symptoms may improve earlier than others in the treatment process, according to pooled analysis of 2 randomised, placebo-controlled trials.

Barbara O. Rothbaum, PhD, professor of psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States, presented the new evidence here at the American Psychiatric Association 2007 Annual Meeting (APA).

The data presented was from a secondary analysis conducted to see precisely which symptoms responded first. "In a PTSD patient with nightmares, for example, we wanted to know when to expect symptoms to respond to treatment," she explained.

Following initiation of acute treatment with venlafaxine XR, the researchers examined the onset of activity and time of response of PTSD symptoms. In their poster, the researchers note that "changes in some symptoms in patients with PTSD, such as anger, may improve earlier than other symptoms and, in turn, may modulate improvement in symptoms that respond later to treatment."

Patients were evaluated for onset of activity and time to response of PTSD symptoms measured by the 17-item Clinician-Administered PTSD Scale-Symptom score (CAPS-SX). The study design recorded mean changes from baseline and response rates over a 6-visit, 12-week period and were evaluated by analysis of variance and logistic regression, respectively, with baseline severity as covariate.

The patient population was made up of 687 "all comers" (ie, people exposed to highly stressful and traumatic events, and not 1 specific group). Of the 687 patients, 347 were given placebo and 340 were given venlafaxine XR.

The venlafaxine XR group showed promising results with significant (P </=.05) separation from placebo on most of the CAPS-SX items, with the earliest onset (weeks two-four) of activity and response on intrusive recollections, psychological distress at exposure to cues, psychological reactivity on exposure to cues and irritability or anger outbursts.

The study documented that onset of activity and response occurred later -- generally in weeks 6 through 8 -- on items such as diminished interest/participation in activities, detachment or estrangement, restricted range of affect, sense of foreshortened future associated with a numbing response, difficulty concentrating, hypervigilance, exaggerated startle response associated with hyperarousal, and avoidance of thoughts/feelings or conversations.

Only the inability to recall important aspects of the trauma failed to measurably separate from placebo on either measure, which Rothbaum said was to be expected.

The researchers concluded that the symptoms of psychological distress, physiological reactivity, and irritability/anger outbursts showed an "early and robust improvement with venlafaxine XR treatment." Other symptoms, such as numbing and hyperarousal took longer to ameliorate, "providing possible insights into the sequence of response" one might expect in this particular pharmacologic treatment, the researchers said.

The study was supported by funding from Wyeth Research.

[Presentation title: Onset of Activity and Time to Response on CAPS-SX17 Individual Items in Patients With Posttraumatic Stress Disorder Treated With Venlafaxine XR: A Pooled Analysis. Abstract NR627]

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