title: Pharmacological treatment of comorbid PTSD and substance use disorder: recent progress.
abstract: Previous research has identified a strong association between posttraumatic stress disorder (PTSD) and substance use disorder (SUD), necessitating the development of treatments that address both conditions. Some pharmacotherapies are effective for the treatment of PTSD and SUD alone, however; no medications have been proven to be effective for the combination of these conditions. We review the recent advances in pharmacological treatment of comorbid PTSD and SUD. A randomized clinical trial of sertraline, a serotonin reuptake inhibitor (SSRI), did not show overall efficacy for comorbid PTSD and alcohol dependence (AD), although it may have efficacy among light drinkers. Another clinical trial demonstrated the efficacy of both disulfiram and naltrexone for the treatment of AD in individuals with PTSD. A more recent clinical trial suggested that norepinephrine uptake inhibitors may also have efficacy for the treatment of comorbid PTSD and AD. In animal and preliminary human studies, brain norepinephrine and glutamate/GABA have emerged as potential treatment targets for comorbid PTSD and SUD. Noradrenergic medications that are promising for comorbid PTSD and SUD include prazosin, guanfacine, and atomoxetine. Promising glutamate/GABA medications include topiramate, memantine, acamprosate, N-acetylcysteine (NAC), and ketamine. The safety and efficacy of these medications for the treatment of PTSD and SUD need to be tested in controlled clinical trials.
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States. Electronic address: Mehmet.Sofuoglu@yale.edu.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
authors.forename: Ismene
authors.initials: I
authors.lastname: Petrakis
mesh_terms: D018663:Adrenergic Agents / Q000627:therapeutic use; D000322:Adrenergic Agonists / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D004359:Drug Therapy, Combination; D018682:GABA Agents / Q000627:therapeutic use; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D014728:Veterans / Q000523:psychology
chemical_list: D018663:Adrenergic Agents; D000322:Adrenergic Agonists; D000928:Antidepressive Agents; D018682:GABA Agents; D009638:Norepinephrine
keywords: Alcohol dependence; Comorbidity; PTSD; Pharmacotherapy; Substance use disorder
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