Rivastigmine as an effective add-on to standard treatment of veterans with chronic posttraumatic stress disorder: a case series.
BACKGROUND
After 23 years of the end of the Iran-Iraq war, the country is left with many patients with chronic posttraumatic stress disorder (PTSD) who need close psychiatric services and are in need for recurrent hospitalization. So far, there are no reports of the rivastigmine use in PTSD patients. We report dramatic reduction of symptoms in 3 veterans with chronic PTSD, after rivastigmine augmentation.


METHODS
This report describes the efficacy of rivastigmine as an add-on to standard treatment of 3 Iranian male veterans with chronic PTSD (aged 52, 46, and 45 years) with severe active symptoms in all 3 dimensions of the disorder. Although they had gone through many approved drug treatments (selective serotonin reuptake inhibitors, tricyclic antidepressants, mood stabilizers, antipsychotics, benzodiazepines, β-blockers, and so on), from the beginning of the disorder, their recovery remained poor (PTSD Checklist-Military Version [PCL-M] scores were 67, 71, and 73 before rivastigmine add-on). Rivastigmine was added to the ongoing therapeutic regimens of the patients for 6 months.Evaluating their condition with PCL-M after 1 and 6 months of treatment showed a significant improvement in patients with PTSD (PCL-M scores were 37, 40, and 47 and dropped to 30, 27, and 31, respectively). Hyperarousal symptoms of PTSD in patients are noted to be the most improved. The rivastigmine add-on experience did not report any adverse effects.


CONCLUSIONS
The present study showed that rivastigmine is an effective and safe add-on to treatment of patients with chronic PTSD. This effect could be due to improved cognitive status or cholinergic-adrenergic balance adjustment in patients.
Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Reza
MR
Fayyazi Bordbar
Ali
A
Talaei
D057189:Checklist; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D048448:Phenylcarbamates / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D000068836:Rivastigmine; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D058014:Veterans Health
D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine