WASHINGTON — An antipsychotic medication commonly used by VA to treat combat-related PTSD has been found to have no discernible benefit. Patients taking the drug risperidone (Risperdal) did no better than those taking a placebo, according to a recent VA-run study.

Veterans’ advocates expressed dismay that patients were being given medication that was “pretty much useless.”

Second-Line Drug

Currently, selective serotonin reuptake inhibitors (SSRIs) such as Paxil and  Zoloft, are the only FDA-approved medications for PTSD. They primarily affect the neurotransmitter serotonin, which helps regulate mood, anxiety, sleep and other body functions. A number of controlled trials have shown these drugs to be effective in treating PTSD, and they remain the preferred first-line pharmaceuticals in treatment. Smaller trials have also been conducted on newer antidepressants in treating PTSD and in treating the comorbid major depressive disorder that frequently accompanies PTSD.

However, even the FDA-approved SSRIs have shown minimal impact on chronic PTSD, so many VA patients do not respond to SSRI therapy or have residual symptoms following the use of SSRIs. In these cases, physicians may turn to atypical antipsychotics, such as Risperdal.

Risperdal has been found successful in treating schizophrenia, bipolar disorder and some of the symptoms of autistic disorder. The drug acts primarily on the dopaminergic and serotonergic systems and is commonly used to treat behavior problems such as aggression, self-injury and sudden mood changes seen in autistic teenagers and children.

It and other second-generation antipsychotics have been used also by VA physicians as adjunctive therapy for PTSD patients who did not respond to first-line medications. Doctors believed it could improve the hyperarousal and re-experiencing symptoms of PTSD in the same way it improved other behavioral problems.

Prior to this most recent study, there was one positive trial for risperidone as monotherapy. That trial looked at women with PTSD related to sexual assault and domestic abuse. There also were three positive trials and two negative trials of risperidone as adjunctive therapy. Most of these were in veterans with combat-related PTSD.

Nearly 87,000 VA patients suffering from PTSD — approximately 20% of VA’s total number of PTSD patients — were prescribed an antipsychotic in 2009.