Burek Gregory A, Waite Mindy R, Heslin Kayla, Liewen Amanda K, Yaqub Tareq M, Larsen Sadie E
Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI, 53233, USA.
J Psychiatr Res. 2021 May;137:480-485. doi: 10.1016/j.jpsychires.2021.03.008. Epub 2021 Mar 16.
Posttraumatic stress disorder (PTSD) symptoms of hyperarousal are mediated through sympathetic nervous system hyperactivity. PTSD symptoms, including distressing thoughts and memories, flashbacks, hyperarousal, and sleep disturbances, have been linked with elevated norepinephrine levels in the cerebrospinal fluid. Clonidine, an alpha2-adrenergic agonist, reduces the release of norepinephrine and has been suggested as a treatment for PTSD. However, literature for use of clonidine in PTSD is limited. The objective of this study was to evaluate clinical records of patients with PTSD treated with clonidine to assess reported efficacy and safety. A cohort of veterans with PTSD treated with clonidine at a midwestern VA hospital between July 2015 and January 2018 were studied retrospectively. Medical records of 79 patients with moderate to severe PTSD symptoms were reviewed by three independent clinicians using the Clinical Global Impressions (CGI) scale to quantify symptom severity (CGI-S) before starting clonidine and subjects' change in symptoms (CGI-I) after starting clonidine. Data on adverse events were also collected. Subgroup analyses were conducted on the impact of comorbid diagnoses, concurrent medications, and substance use. Mean CGI-S score at baseline was 4.8 (5 = markedly ill). After treatment with low-dose clonidine, 72% of patients experienced improvement, and 49% scored "much improved" or "very much improved." Adverse effects were reported by 18 out of 79 subjects. In this retrospective analysis of veterans prescribed clonidine for PTSD, CGI-I scores suggested improvement in PTSD symptoms, and minimal side effects were reported. In addition, some comorbid diagnoses and concurrent medications were correlated with variations in outcomes.
创伤后应激障碍（PTSD）的过度觉醒症状是由交感神经系统功能亢进介导的。PTSD症状，包括痛苦的想法和记忆、闪回、过度觉醒和睡眠障碍，与脑脊液中去甲肾上腺素水平升高有关。可乐定是一种α2肾上腺素能激动剂，可减少去甲肾上腺素的释放，已被建议用于治疗PTSD。然而，关于可乐定在PTSD治疗中的文献有限。本研究的目的是评估接受可乐定治疗的PTSD患者的临床记录，以评估报告的疗效和安全性。回顾性研究了2015年7月至2018年1月期间在中西部一家退伍军人事务部（VA）医院接受可乐定治疗的一组PTSD退伍军人。三名独立的临床医生使用临床总体印象（CGI）量表对79例中度至重度PTSD症状患者的病历进行了审查，以量化开始使用可乐定前的症状严重程度（CGI-S）以及开始使用可乐定后患者症状的变化（CGI-I）。还收集了不良事件的数据。对共病诊断、同时使用的药物和物质使用的影响进行了亚组分析。基线时的平均CGI-S评分为4.8（5=明显患病）。低剂量可乐定治疗后，72%的患者症状有所改善，49%的患者评分“改善很多”或“改善非常多”。79名受试者中有18名报告了不良反应。在这项对开具可乐定治疗PTSD的退伍军人的回顾性分析中，CGI-I评分表明PTSD症状有所改善，且报告的副作用最小。此外，一些共病诊断和同时使用的药物与疗效差异相关。
