Doctors Try Using Drugs Off-Label to Cure PTSS and Substance Abuse

Posttraumatic stress syndrome and substance abuse disorders are among the hardest mental disorders to treat. People with posttraumatic stress disorders often spend years in psychotherapy without making significant progress in alleviating their symptoms, which can be debilitating enough to affect their everyday lives. Those with substance abuse disorders can go through expensive residential addiction treatments, and then relapse into their old lifestyles.

When a physician is presented with the patient who has a treatment-resistant condition, they may sometimes prescribe a drug “off-label.”

“Often in psychiatry, we think , if something works for one condition, it could possibly be effective for another one,” said Dr. Alicia Maher, a researcher at the RAND Health Center in Santa Monica, California.

A new study from the Universidade Federal de Sao Paulo in Brazil found that topiramate, an anti-seizure medication, could be used off-label in treating post-traumatic stress syndrome.

Prof. Mary Yeh and her colleagues first tested the symptoms of 35 patients with posttraumatic stress syndrome and then divided them into two groups. One group received topiramate, and the other took a placebo. Over 82% of the patients who got the real drug showed significant improvement in symptoms such as intrusive memories, flashbacks, nightmares, social isolation, and emotional numbness compared to the placebo group.

Topiramate is sold under the brand names Topamax and Topiragen. It is used to treat epilepsy, obesity, migraine and cluster headaches, and tremor. Side effects can be slowed reaction, difficulty concentrating, speech and memory problems, confusion, nervousness, mood swings, depression, weight loss, constipation, and more. The drug is linked to kidney and menstrual problems and interacts with many medications.

Dr. Yeh’s study was published in the journal CNS Neuroscience & Therapeutics.

In another research project, Dr. Maher and her colleagues analyzed data from 162 scientific studies that compared atypical antipsychotic drugs to placebos when used for conditions that fell outside the drug’s original approved purposes. They found that these medications, including risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify) had no effect on patients with eating disorders or drug or alcohol abuse disorders. It was not clear if the drugs helped people with posttraumatic stress disorder. The drugs also caused side effects such as weight gain and fatigue.

Dr. Maher, writing in the Journal of the American Medical Association, reported that if a doctor is using an anti-psychotic for such conditions, “you want to ask him or her on what basis they expect a response, as well as how safe you as an individual may be from various side effects.”