Serotonergic Synergy in the Pharmacotherapy of Acute Posttraumatic Stress Disorder Exacerbation: A Case Report

• Published in: Military medicine 2017-01, Vol.182 (1), p.e1673-e1677
• Main Authors: Pennington, J Gibson, Guina, Jeffrey
• Format: Article
• Language: English
• Subjects: Adult; Antipsychotic Agents - pharmacology; Antipsychotic Agents - therapeutic use; Drug Synergism; Fear; Histamine H1 Antagonists - pharmacology; Histamine H1 Antagonists - therapeutic use; Humans; Hydroxyzine - pharmacology; Hydroxyzine - therapeutic use; Male; Piperazines - pharmacology; Piperazines - therapeutic use; Propranolol - pharmacology; Propranolol - therapeutic use; Serotonin Agents - pharmacology; Serotonin Agents - therapeutic use; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - drug therapy; Suicidal Ideation; Thiazoles - pharmacology; Thiazoles - therapeutic use; Vasodilator Agents - pharmacology; Vasodilator Agents - therapeutic use
• ISSN: 0026-4075; 1930-613X
• DOI: 10.7205/MILMED-D-15-00572

Posttraumatic stress disorder (PTSD) is often associated with acute panic, dissociation, suicidality, and aggression. However, pharmacologic interventions for such acute exacerbations are understudied. In this article, we report a case of combat-related PTSD with severe panic, suicidality, and agitation which responded favorably to a combination of ziprasidone, propranolol, and hydroxyzine. An extensive literature search did not reveal any use of this combination, and there were few studies about each medication individually, with regard to PTSD. We reviewed current literature to provide potential explanations for the case. Our case report describes a novel medication regimen which was used to treat an acute PTSD exacerbation. We explore possible biochemical explanations examining the pharmacologic profiles of ziprasidone, propranolol, and hydroxyzine. These medications each have relatively rapid onset and unique serotonergic activities. Given the role of serotonin in fear conditioning and traumatic memory consolidation, these treatments could be of significant benefit for PTSD patients, especially in the acute setting. We believe the treatments warrant further research to determine whether they are potential alternatives for anxiolytics like benzodiazepines, which are frequently used clinically but have evidence of risks in and little efficacy for PTSD.