Veterans with post-traumatic stress disorder (PTSD) treated with clonidine, a drug traditionally used to treat high blood pressure and sometimes attention deficit hyperactivity disorder, had reduced severity of PTSD symptoms, according to a new study from Advocate Aurora Health researchers.
The retrospective study, recently published in the Journal of Psychiatric Research, found that patients with PTSD at a midwestern Veteran Affairs hospital who were prescribed low-dose clonidine demonstrated significant reductions in the severity of their PTSD symptoms as measured according to the Clinical Global Impressions (CGI) scale. After treatment with low-dose clonidine, 72% of patients experienced improvement, and 49% scored “much improved” or “very much improved.”
“Veterans with PTSD are more likely to face substance abuse, anger issues, mental health disorders, marriage instability, unemployment and suicidal ideation,” said lead author Gregory Burek, MD, an Advocate Aurora psychiatrist in the Veterans Retraining Program. “With PTSD rates as high as 31% for U.S. veterans, the effect of this highly disabling disorder on our veteran community presents a clear clinical need.”
“Treatments for PTSD typically include medications and psychotherapy, but research indicates that there is significant variability in treatment response,” said coauthor Mindy Waite, PhD, research scientist with Advocate Aurora Research Institute’s Ed Howe Center for Health Care Transformation and Aurora Behavioral Health Services. “This means that we need to test additional interventions to ensure that everyone can get the effective treatments they need.”
Symptoms of hyperarousal, such as distressing flashbacks and sleep disturbances, have been linked with elevated spinal fluid levels of the naturally occurring chemical norepinephrine. Because of its ability to regulate norepinephrine levels, clonidine, which is used to treat other conditions often characterized by hyperarousal symptoms, has been suggested as a potential treatment for PTSD. Until now, however, studies evaluating clonidine as a PTSD treatment have been limited.
Previous research suggests clonidine may be particularly effective in treating nighttime symptoms of PTSD, such as sleep disturbances, which also tend to exacerbate other symptoms. First-line medications for PTSD, such as selective serotonin reuptake inhibitors, or SSRIs, have shown little impact on nighttime PTSD symptoms and also appear less effective for veterans with PTSD than other populations with PTSD.
The objective of the study was to evaluate health records of patients with PTSD treated with clonidine to assess its reported efficacy and safety.
The authors ultimately examined the health records of 79 patients with moderate to severe PTSD who were treated with clonidine between July 2015 and January 2018. Using the CGI scale, the researchers quantified symptom severity before and after patients began low-dose clonidine treatment.
The team also collected data on clonidine-related adverse events and found only minor events reported in a subpopulation of patients. Additionally, the study findings suggest that other clinical variables, such as substance use, potentially influenced outcomes.
“The results of this study are particularly exciting because of clonidine’s potential advantages over other treatment options,” Dr. Burek said. “Compared to other medications used to treat PTSD, such as SSRIs, clonidine has a shorter response time and fewer side effects. Treatment with clonidine also opens up the possibility of combination treatments, perhaps with an SSRI. In fact, our analysis found significantly improved treatment response when patients were prescribed both clonidine and an SSRI.”
The authors suggest their study results should prompt future research of clonidine’s effectiveness in treating PTSD through randomized, controlled clinical trials.
“Advocate Aurora is proud to support research such as this that can help guide our clinicians toward alternative treatment options,” said Pete Carlson, president of Advocate Aurora Behavioral Health Services. “Though more research is needed, Dr. Burek and Dr. Waite’s study findings could one day lead to a major treatment shift for our patients, particularly veterans, suffering from PTSD.”
To learn more about Advocate Aurora’s research, visit aurora.org/research.