An open-label study of mirtazapine as treatment for combat-related PTSD.

BACKGROUND: Posttraumatic stress disorder (PTSD) is common among war veterans. Antidepressants are effective in reducing symptoms and associated disability for some patients. OBJECTIVE: To assess the effectiveness of mirtazapine for combat-related PTSD among veterans treated in an Australian hospital. METHODS: This open-label prospective study assessed the effectiveness of mirtazapine as empirical treatment for combat-related PTSD. The initial dose was 15 mg at night, titrated against response to 15-45 mg. PTSD symptoms were assessed using the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Clinician-Administered PTSD Scale (CAPS). Subjects also completed the Hospital Anxiety and Depression Scale (HADS). Body weight and biochemical assessments, including fasting blood glucose (FBG), total serum cholesterol, and serum triglycerides, were also measured. Baseline measurements were repeated after 12 weeks. RESULTS: During the 18-month recruitment phase, 17 subjects were enrolled and 13 completed the protocol. The CAPS measurement decreased from a mean pretreatment score of 87.5 to 64.4 (p = 0.01). In 4 cases, the CAPS score decreased to below the diagnostic cut-point, consistent with a remission of PTSD. The Mississippi scale measurement decreased from a mean pretreatment score of 126.6 to 115.5 (p < 0.01). The mean HADS anxiety score decreased from 15.6 +/- 4.2 to 13.5 +/- 5.6 (p = 0.016), although the proportion of subjects with scores above the diagnostic cut-point remained high. The mean HADS depression score at baseline was not significantly different from the postintervention score. One subject had a postintervention FBG of 155 mg/dL (consistent with diabetes mellitus), which was increased from the baseline level of 83 mg/dL. All subjects experienced an increase in body weight. One subject had an increase in body weight of 8.75 kg (8.4%) from baseline. CONCLUSIONS: Although small and with methodological limitations, this study suggests that mirtazapine is an effective treatment for combat-related PTSD. Additional research incorporating an appropriately powered, double-blind, placebo-controlled study design is required.

Topiramate in combat-related posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that is common among combat veterans and may lead to very poor sleep and disturbing nightmares. OBJECTIVE: To examine the safety and effectiveness of topiramate as add-on therapy for the management of combat-related PTSD and to examine the effects of topiramate on sleep and alcohol consumption. METHODS: We conducted an 8-week open-label pilot study of topiramate for male combat veterans (N = 43) with PTSD, with analysis of veterans who completed the protocol. Psychometric, sleep, and alcohol consumption assessments were conducted at baseline and at week 8. RESULTS: Twenty-nine subjects completed the 8-week study. Significant reductions in Clinician Administered PTSD Scale scores were observed at the 8-week endpoint (from 86.3 +/- 21.1 to 67.1 +/- 25.1; p < 0.01). Decreases were seen in both Stanford Sleepiness Scale scores (from 10.5 +/- 0.72 to 9.0 +/- 0.58; p = 0.08) and Mississippi PTSD scores (from 120.4 +/- 6.5 to 111.5 +/- 20.9; p = 0.08), but the extent of the changes did not attain statistical significance for either scale. There was a significant reduction in the proportion of patients with nightmares (from 100% to 62%; p < 0.001) and patients who experienced anxiety that interfered with falling asleep (from 90% to 62%; p < 0.05). The proportion of patients with high-risk drinking patterns also decreased (from 31% to 14%). Two serious adverse events were reported during the study: an increase in low back pain and an episode of acute confusion. CONCLUSIONS: When used in addition to other empiric therapy, topiramate may be effective at reducing general symptoms of combat-related PTSD and reducing high-risk alcohol intake and nightmares. Further randomized controlled trials of topiramate for the treatment of combat-related PTSD are warranted.

Factors that adolescent males take into account in decisions about an unplanned pregnancy.

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447-458], and extends the findings of that study. Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partner's pregnancy. Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as 'well-balanced' (80.6%), and the two minority groups as 'unwilling/unready' (10.9%) and 'family-centred' (8.5%). Group membership was strongly predictive of the males' final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.

The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood.

OBJECTIVE: In comparison to its female counterpart, the transition of men to parenthood has been relatively neglected in previous research. The present paper argues that men may have gender-specific risk factors for perinatal psychological distress and may manifest distress in ways different from women. The prime objective of this research was to document changes in psychological, relationship and lifestyle parameters in a cohort of first time fathers from pregnancy to the end of the first postnatal year. The present paper reports on these changes. METHOD: Three hundred and twelve men were assessed at 23 weeks of pregnancy and followed up at 3, 6 and 12 months postnatally, using a battery of self-report questionnaires covering psychological symptom levels, lifestyle variables and relationship/sexual functioning. Two hundred and four men completed all four assessments. RESULTS: The men exhibited highest symptom levels in pregnancy with general, through small, improvement at 3 months and little change thereafter. Lifestyle variables showed small changes over the first postnatal year. Sexual functioning appeared to deteriorate markedly from pre-pregnancy levels with only minimal recovery by the end of the first year. The results highlight that the majority of men anticipated return of sexual activity to pre-pregnancy levels; however, this failed to eventuate. CONCLUSIONS: Pregnancy, rather than the postnatal period, would appear to be the most stressful period for men undergoing the transition to parenthood. The results suggest that the most important changes occur relatively early in pregnancy. Thereafter, lack of change (rather than change) is the most noteworthy feature. These men appeared to be ill-prepared for the impact of parenthood on their lives, especially in terms of the sexual relationship. Further research to determine the timing and trigger of stress in pregnancy is recommended.

To screen or not to screen--that is the question in perinatal depression.

Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. Screening provides an opportunity to access large numbers of women and facilitate pathways to best-practice care. A valid, reliable, economical screening tool (the Edinburgh Postnatal Depression Scale, EPDS) is available. Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.