USE OF THIORIDAZINE IN POSTTRAUMATIC-STRESS-DISORDER

ALTHOUGH the term ''post-traumatic stress disorder'' (PTSD) is relativ ely new in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III-R, 3rd edition), the condition of ''traumatic neurosis'' was f irst described in the late 19th century by Alder,(1) who believed the characteristic symptoms were due to organic factors occurring at the m olecular level and affecting electrical conductivity in the nervous sy stem. Since that time, numerous theories of etiology, behavioral manif estations, and treatment modalities have been proposed. The three majo r features of PTSD are the re-experiencing of the trauma through dream s and waking thoughts; emotional numbing, especially in relationships; and symptoms of autonomic instability, depression, and cognitive diff iculties such as poor concentration.(2) Antidepressant agents, especia lly the tricyclics amitriptyline and imipramine, and monoamine oxidase inhibitors such as phenelzine are the drugs most commonly used to tre at the symptoms of PTSD.(2) Clonidine and propranolol may also prove u seful. Carbamazepine and lithium have been tried in PTSD with promisin g results, although the usefulness of these agents has been limited by patient noncompliance due to dose-related side effects such as gastro intestinal disturbances, sedation, and dysphoria.(3,4) Fesler(5) recen tly demonstrated the beneficial use of valproate in 16 Vietnam veteran s with DSM-III-R combat-related PTSD. More recently, fluoxetine combin ed with clonazepam provided relief of persistent hyperarousal symptoms , including insomnia, nightmares of combat, and flashbacks.(6) The use of clomipramine may also prove beneficial, especially with the severe intrusive symptoms of PTSD.(7) Antipsychotic agents have been used in the treatment of PTSD, primarily in the treatment of paranoid symptom s. These agents may also prove useful in patients with overwhelming an ger, self-destructive behavior, or extreme auditory and/or visual hall ucinations. However, it is generally recognized that antipsychotic age nts, although the drugs of choice in frank psychosis, have no place in the routine treatment of PTSD.(8) With the great number of agents use d clinically today, pharmacologic treatment remains controversial, wit h no clear-cut drug of choice. We add to this controversy and present a case report in which the use the antipsychotic thioridazine proved b eneficial in the treatment of PTSD.