Letters to the Editor
Treatment Of Posttraumatic Stress Disorder With Tiagabine
Posttraumatic stress disorder (PTSD) can be a debilitating condition with
impairment as bad as, or worse than, that caused by other psychiatric illnesses
(1). Symptomatology includes a triad of symptoms from 3 clusters: persistent
reexperiencing of the trauma (for example, intrusive and distressing recollections,
nightmares, and dissociative flashbacks); persistent avoidance of stimuli
associated with the trauma; and persistent symptoms of increased autonomic
arousal (2). Because the symptoms of PTSD can vary across the symptom clusters,
medications from different classes are needed to treat patients. Based
on the hypothesis that kindling of the limbic nuclei occurs following the
trauma (3–5), anticonvulsants such as carbamezapine and valproate were
used to treat PTSD as far back as the mid-1980s to the early 1990s, (6,7).
Newer anticonvulsants such as lamotrigene, gabapentin, and topiramate have
also been used (8–10).
I present the case of a patient diagnosed with PTSD and major depressive
disorder (MDD) who had taken multiple medications in the past and received
benefit from tiagabine. To date, there are no reports in the literature
describing the use of tiagabine to treat PTSD.
Mr A is a 43-year-old man with a history of PTSD and MDD. His illness caused
significant impairment over the years, and he had been treated with the
following agents: sertraline, paroxetine, fluoxetine, buproprion augmented
with lithium, trazadone, nefazodone, gabapentin, and topiramate.
Upon consultation, Mr A agreed to a trial of venlafaxine extended release
(XR), started at 37.5 mg daily and titrated to 225 mg daily over 3 weeks.
After 1 month, he noted an improvement in his depressive symptoms, but
he was still experiencing intrusive thoughts, nightmares, and hypervigilance.
He agreed to a trial of tiagabine, initiated at 2 mg daily. His dosage
was increased by weekly 2 mg increments to 8 mg daily, at which level he
began to notice an improvement in his intrusive thoughts and nightmares—even
through the traumatic events of September 11, 2001, which provided a flood
of external cues. He occasionally takes zolpidem tartrate 10 mg for insomnia,
but over the past 6 months he has improved significantly, to the point
of returning to work full-time. He cannot recall feeling this stable during
the last 10 years.
Tiagabine is FDA-approved as an adjunct anticonvulsant for the treatment
of partial seizures (11). It is thought to exert its action by inhibiting
GABA from the synaptic cleft (12,13). Tiagabine has also been shown to
have antikindling potency (14), making it a potential candidate in treating
PTSD. This patient’s improvement might have been due to a combination of
agents, but the addition of tiagabine clearly led to a reduction in the
reexperiencing symptoms. Further controlled studies are needed to investigate
the efficacy of tiagabine in treating PTSD.
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others. Effects of tiagabine and vigabatrin on GABA uptake into primary
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Timothy Berigan, DDS, MD