title: Efficacy and Tolerability of High-Dose Escitalopram in Posttraumatic Stress Disorder.
abstract: BACKGROUND
  Open-label trials suggest that escitalopram (up to 20 mg/d) is an effective treatment for some, but not all posttraumatic stress disorder (PTSD) patients. Higher doses of escitalopram effectively reduced major depression symptoms in patients who had not responded to regular doses. The current study examines the efficacy, tolerability, and adherence to high-dose escitalopram in PTSD.
  
  
  METHODS
  Forty-five PTSD patients received 12 weeks of gradually increasing doses of escitalopram reaching 40 mg daily at 4 weeks. Among those, 12 participants received regular doses of antidepressants at study onset including escitalopram (n = 7). The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD symptoms severity before treatment, at 3 months (upon treatment termination), and at 6 months (maintenance effect). A 20% reduction in CAPS scores was deemed clinically significant.
  
  
  RESULTS
  Adverse events and medication adherence were monitored at each clinical session. Linear mixed-models analysis showed a significant reduction of mean CAPS scores (11.5 ± 18.1 points) at 3 months and maintenance of gains by 6 months (F2,34.56 = 8.15, P = 0.001). Eleven participants (34.3%) showed clinically significant improvement at 3 months. Only 9 participants (20%) left the study. There were no serious adverse events and few mild ones with only 2 adverse events (diarrhea, 11.1%; drowsiness, 11.1%) reported by more than 10% of participants.
  
  
  CONCLUSIONS
  High doses of escitalopram are tolerable and well adhered to in PTSD. Their beneficial effect at a group level is due to a particularly good response in a subset of patients.Variability in prior pharmacological treatment precludes a definite attribution of the results to high doses of escitalopram.
authors.affiliation: From the Department of Psychiatry, NYU Langone Medical Center, New York, NY.
authors.forename: Wei
authors.initials: W
authors.lastname: Qi
authors.forename: Martin
authors.initials: M
authors.lastname: Gevonden
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalev
mesh_terms: D000328:Adult; D015283:Citalopram / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors