Antipsychotics Prescribed More Often for Depression Plus PTSD

Roberta Friedman, PhD

May 22, 2003

May 22, 2003 (San Francisco) — Antipsychotics are more likely to be prescribed to Veterans Affairs (VA) patients with depression combined with posttraumatic stress disorder (PTSD) compared with those who are suffering from depression without other conditions.

"The literature doesn't support this" practice, investigator Kiran Khanuja, MD, who presented the poster, told Medscape in an interview. Dr. Khanuja, a resident in the psychiatry department at the University of Michigan in Ann Arbor, added that only one study backs up the use of such strong drugs in PTSD.

Investigators combed the VA national registry for depression, and came up with 45,834 patients with depression and PTSD. They also looked at 141,955 VA patients with just depression as the diagnosis.

While the two groups used antidepressant medications at similar rates, those with both conditions were 2.4 times more likely to use antipsychotics (95% confidence interval, 2.31 - 2.45; P < .0001).

Twenty percent of patients with both conditions took antipsychotics. Only 8.8% of those with just depression as the diagnosis were taking these drugs. "Much of the use was long term," Dr. Khanuja told Medscape. On average, patients used the agents for 249 days.

Stephen Brannan, MD, who used to work on PTSD and had been at the VA in San Antonio, Texas, commented for Medscape that the important point is which antipsychotics are being used. "If it were haloperidol, I'd have a concern," Dr. Brannan said.

"Two or three of the atypical [antipsychotics] do have some benefit" in PTSD, Dr. Brannan said, especially on symptoms of flashback and hallucination.

Dr. Brannan pointed out that people seen at the VA tend to have comorbid conditions. PTSD and substance abuse are the most common codiagnosed problems, said Dr. Brannan, who is now with a company called Cyberonics in Houston, Texas.

There is good news and bad news in the VA database, said Dr. Brannan. It shows that 85% of the depressed patients are receiving antidepressants. That's far better than what is typical, he said, because usually only one third of the general population with depression is taking medication.

Yet this also raises the possibility that the more severely depressed patients end up at the VA, Dr. Brannan said. Those who have depression with PTSD also tend not to respond to the usual medications. So these are all reasons why the VA doctors might have tried antipsychotic medications, he said.

The study was funded by the Veterans Administration Center for Practice Management and Outcomes Research.

APA 156th Annual Meeting: Abstract NR607. Presented May 21, 2003.

Reviewed by Gary D. Vogin, MD