title: Pharmacotherapy for posttraumatic stress disorder at a Veterans Affairs facility.
abstract: OBJECTIVE
  Results of a study of psychotropic prescribing patterns in a Veterans Affairs (VA) population with posttraumatic stress disorder (PTSD) are presented.
  
  
  METHODS
  VA prescription records were reviewed to identify veterans with PTSD at a large VA healthcare center and evaluate their medication regimens for conformance with a VA practice guideline that calls for the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line therapies for PTSD; the VA guideline does not recommend second-generation antipsychotics (SGAs) and benzodiazepines for PTSD symptom control. The primary objective was to determine if veterans with PTSD who were receiving an SGA had first received SSRI or SNRI therapy in accordance with VA recommendations.
  
  
  RESULTS
  Among 308 veterans who met the inclusion criteria, the average number of SSRI or SNRI agents prescribed prior to initiation of SGA therapy was 0.88. Only 19.8% of patients (n = 61) had been prescribed 2 SSRI or SNRI agents, with 48.4% of patients (n = 149) having received 1 agent. All evaluated courses of SSRI and SNRI therapy prior to SGA initiation were of sufficient duration (range, 5-30 months), and mean adherence rates were >80%. Current or past benzodiazepine use was documented in about 55% of patients (n = 170).
  
  
  CONCLUSIONS
  SSRIs and SNRIs were under-utilized for the treatment of PTSD at the study site in patients receiving an SGA. The current use of benzodiazepines in these patients was lower than a reported national average for VA patients.
authors.affiliation: Tracie M. Kobayashi, Pharm.D., BCPS, is Clinical Pharmacist, Veterans Affairs Pacific Islands Health Care System, Honolulu, HI; when this study was conducted, she was Postgraduate Year 1 Pharmacy Resident, Veterans Affairs Southern Nevada Healthcare System, Las Vegas. Meeta Patel, Pharm.D., CDE, BCPS, is Director of Pharmacy Education and Training; and Megan Lotito, Pharm.D., BCPP, is Psychiatric Pharmacy Specialist, Veterans Affairs Southern Nevada Healthcare System, Las Vegas. tracie.kobayashi@va.gov.
authors.forename: Tracie M
authors.initials: TM
authors.lastname: Kobayashi
authors.affiliation: Tracie M. Kobayashi, Pharm.D., BCPS, is Clinical Pharmacist, Veterans Affairs Pacific Islands Health Care System, Honolulu, HI; when this study was conducted, she was Postgraduate Year 1 Pharmacy Resident, Veterans Affairs Southern Nevada Healthcare System, Las Vegas. Meeta Patel, Pharm.D., CDE, BCPS, is Director of Pharmacy Education and Training; and Megan Lotito, Pharm.D., BCPP, is Psychiatric Pharmacy Specialist, Veterans Affairs Southern Nevada Healthcare System, Las Vegas.
authors.forename: Meeta
authors.initials: M
authors.lastname: Patel
authors.affiliation: Tracie M. Kobayashi, Pharm.D., BCPS, is Clinical Pharmacist, Veterans Affairs Pacific Islands Health Care System, Honolulu, HI; when this study was conducted, she was Postgraduate Year 1 Pharmacy Resident, Veterans Affairs Southern Nevada Healthcare System, Las Vegas. Meeta Patel, Pharm.D., CDE, BCPS, is Director of Pharmacy Education and Training; and Megan Lotito, Pharm.D., BCPP, is Psychiatric Pharmacy Specialist, Veterans Affairs Southern Nevada Healthcare System, Las Vegas.
authors.forename: Megan
authors.initials: M
authors.lastname: Lotito
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D006787:Hospitals, Veterans; D006801:Humans; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D013997:Time Factors; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors