Researchers identify an existing drug that may be an effective new PTSD treatment
Collaboration between teams at Boston University School of Public Health and the Department of Veterans Affairs outline latest development
Eight percent of the US general population will develop posttraumatic stress disorder (PTSD) at some point in their life, making it the fifth-most prevalent mental disorder in the country. PTSD is a particularly salient problem among military veterans—over 10% of Department of Veterans Affairs (VA) patients have a PTSD diagnosis. Thus, it’s not surprising that PTSD has been described as conferring a huge burden to individuals and society. Advancements in PTSD treatment have taken on significant priority for clinicians and researchers.
In a previous blog post, we described a detailed scope of this issue and plans for a grant (#R01MH121397 — which was awarded to investigators at Boston University School of Public Health and the Department of Veterans Affairs) to examine whether existing medications may have off-label beneficial effects on PTSD symptoms. With this study now well underway, initial findings from the first exploratory analysis have been published in a recent issue of Biological Psychiatry. This paper reports the drugs that we found to be associated with a clinically meaningful improvement in PTSD symptoms between two clinical visits. Our results are summarized below.
Replicating known effects
Given our use of an exploratory statistical method (TreeScan), it was reassuring that our analyses documented medications that are known to have some effect on the improvement of PTSD symptoms. Specifically, Sertraline, an FDA-approved PTSD treatment, had an association with PTSD symptom improvement that was generally weak in magnitude; an effect that is consistent with the existing literature and clinical experience. Other medications commonly prescribed for PTSD and related mood disorders like citalopram, fluoxetine, trazodone, and lithium had similarly small associations with PTSD symptom improvement. Prazosin, which is commonly prescribed for PTSD-related nightmares, also had a similar effect. Several drugs commonly used in detoxification and addiction treatment also demonstrated associations with PTSD symptom improvement. Two opioid antagonists, naloxone and naltrexone, were associated with improvements in PTSD symptoms.
Novel PTSD treatment findings
Unexpectedly, we found that Hepatitis C Virus (HCV) Direct Acting Antivirals (DAA) including glecaprevir, pibrentasvir, and velpatasvir had the strongest association with clinically significant PTSD symptom improvement among all drugs examined. Of note, glecaprevir and pibrentasvir demonstrated associations that were identical in magnitude, which is explained by the fact that they are co-prescribed under the brand name Mavyret. This association was maintained among persons who received no concurrent PTSD treatment during their experience with Mavyret, indicating that our overall observation was not strictly due to PTSD symptom improvement specifically related to established PTSD treatments such as trauma-focused psychotherapy.
These novel findings may mean that we are one small step closer to discovering new PTSD treatments using existing medications. There is a lot more work that needs to be done before these findings could be used in clinical practice, but it’s the first step in a potential improved change to PTSD treatment and improvements in populations affected by this condition.
Next steps
Currently, we’re examining the specific medications identified as potentially effective in our exploratory study with more rigorous casual methods to determine if the observed PTSD symptom improvement remains after accounting for other factors that may explain this observation. Further, we are conducting analyses to determine if a similar effect is observed for other psychiatric outcomes that are commonly comorbid with PTSD, such as depression and alcohol use. In addition, although there are several potential hypotheses regarding how an HCV DAA drug would impact PTSD symptom improvement, further examination of potential biological mechanisms is needed. Ultimately, these findings can form the basis for a clinical trial to determine if DAA’s are an effective PTSD treatment among persons without HCV.
If subsequent studies continue to document a robust association, these findings can save millions of dollars in research and development and be life-changing to our veterans and other populations who experience PTSD. We hope this line of research continues to be successful, and ultimately brings new PTSD treatment options to those who need them most.
Dr. Jaimie Gradus is an Associate Professor of Epidemiology at Boston University School of Public Health and an Associate Professor of Psychiatry at Boston University School of Medicine. Her research interests are in the epidemiology of trauma and trauma-related disorders, with a particular focus on suicide outcomes.
