Tiagabine for posttraumatic stress disorder: A case series of 7 women

Background. Posttraumatic stress disorder (PTSD) is often a chronic disorder, and, though 2 antidepressants are now approved by the U.S. Food and Drug Administration for its treatment, it often remains refractory to pharmacotherapy. The memory of traumatic events, by repeatedly stimulating the hippocampus and amygdala (kindling phenomenon), may alter multiple biological systems, including gamma-aminobutyric acid (GABA) pathways, and eventually lead to the disorder. Tiagabine, a selective GABA reuptake inhibitor, was evaluated as a treatment for PTSD. Method: Patients with DSM-IV PTSD who were stable on current medications and still symptomatic were eligible for inclusion in this open-label case series. Tiagabine was initiated at 2 mg nightly and increased by 2-mg increments every 2 to 3 days until an optimal response was achieved. The Clinical Global Impress ions-Improvement scale and PTSD Checklist-Civilian Version (PCL-C) were used to evaluate changes in PTSD symptoms. Results: Seven consecutive female patients were identified as eligible. Tiagabine markedly improved PTSD symptoms within 2 weeks for 6 of the 7 patients, and 6 patients were rated as "much improved" or "very much improved." The mean PCL-C score was significantly reduced at weeks 2 and 8 (p < .05) as were the 3 PCL-C subscales and 1 of 2 items related to sleep disturbance. The mean effective daily dosage was approximately 8 mg (range, 4-12 mg/day). Treatment with tiagabine was generally well tolerated. Conclusions: These preliminary open-label findings suggest that the selective GABA reuptake inhibitor tiagabine may be a promising therapeutic option in the treatment of PTSD. Further study into the efficacy and safety of tiagabine for the treatment of PTSD is warranted.