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Predicting response to amitriptyline in posttraumatic stress disorder

J R Davidson1, H S Kudler, W B Saunders

  • 1Department of Psychiatry, Duke University Medical Center, Durham, NC 27710.

The American Journal of Psychiatry
|July 1, 1993
PubMed
Summary
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Lower baseline depression, anxiety, and PTSD symptom severity predict better response to amitriptyline in combat veterans. These findings suggest specific predictors for this antidepressant treatment in posttraumatic stress disorder (PTSD).

Area of Science:

  • Psychiatry
  • Pharmacology
  • Clinical Psychology

Background:

  • Posttraumatic stress disorder (PTSD) is a debilitating condition often treated with pharmacotherapy.
  • Amitriptyline is a commonly prescribed antidepressant for PTSD, but predictors of treatment response are not fully understood.

Purpose of the Study:

  • To investigate the relationship between baseline clinical characteristics and treatment response to amitriptyline in combat veterans with PTSD.
  • To identify specific patient factors associated with positive outcomes when using amitriptyline for PTSD.

Main Methods:

  • An 8-week, double-blind, placebo-controlled study involving combat veterans diagnosed with PTSD.
  • Statistical analyses (bivariate and multivariate) examined correlations between baseline variables (demographics, symptom severity, comorbidities, trauma exposure) and treatment outcomes.

Related Experiment Videos

  • Outcome measures included standardized scales for overall clinical improvement, depression, anxiety, and PTSD symptom impact.

    • Main Results:

    • Treatment response to amitriptyline was associated with lower baseline levels of depression, neuroticism, and combat intensity.
    • Specific symptom clusters, including anxious mood, impaired concentration, somatic symptoms, guilt, and certain PTSD intrusion and avoidance symptoms, predicted better drug response.
    • These associations were specific to the amitriptyline group and not observed in the placebo group.

    Conclusions:

    • Baseline depression, anxiety, PTSD symptom profiles, personality traits (neuroticism), and combat trauma intensity are significant predictors of amitriptyline response in veterans.
    • These findings highlight the potential for using baseline clinical phenomena to personalize amitriptyline treatment selection for PTSD.
    • The observed drug-specific relationships underscore the pharmacological efficacy of amitriptyline in certain PTSD patient subgroups.