Coming up empty

For many veterans with post-traumatic stress disorder (PTSD), the conventional treatments don’t work. Doctors at the Veterans Health Administration’s medical centers offer medications and psychotherapy, but more than 30 percent of PTSD patients in the VA system don’t get significantly better. Since a new batch of antipsychotic medications arrived on the market in the 1990s, doctors have hoped that these drugs could help with the anxiety, flashbacks, insomnia, and other PTSD symptoms that cause suffering and disability. In 2009, about 81,000 veterans were prescribed these drugs.

Unfortunately, a study in the Journal of the American Medical Association that followed a group of these hard-to-treat veterans reached a discouraging conclusion about risperidone, one of the most popular antipsychotic drugs. The study, by a team led by Yale psychiatry professor John Krystal ’84MD, found that the PTSD symptoms of the average patient taking the drug did not improve any more over six months than those who received a placebo. The drug also had side effects—weight gain and sedation.

Krystal, director of the clinical neuroscience division at the VA National Center for PTSD, says that the study will force doctors to reevaluate whether they should prescribe the drugs. “If they have side effects, why would we prescribe them if there’s no real benefit?” he asks.

Krystal says the research highlights a bigger problem than needless prescriptions: the lack of proven, effective drugs to treat PTSD. Psychiatrists treating patients with the disorder have always had to choose among drugs developed for other diseases; there are none specifically for PTSD. “We need a new generation of brain research,” Krystal says.