Navigating New Treatments for PTSD

CONFERENCE REPORTER

In this Mental Health Minute, Lori Davis, MD, of the University of Alabama sits down with Psychiatric Times® and shares highlights from “Navigating the Frontier of Post-Traumatic Stress Disorder Treatment: Exploring Updates in Ketamine and a Novel Therapeutic Clinical Program of Brexpiprazole in Combination With Sertraline,” a panel session she chaired at the 2024 American Society of Clinical Psychopharmacology (ASCP) Annual Meeting. The full transcript is below.

Hello, my name is Dr Lori Davis. I am a professor of psychiatry at the University of Alabama School of Medicine in the Department of Psychiatry, and I was chair of a very exciting panel of talks at the ASCP Annual Meeting in Miami. It was focused on navigating new treatments for posttraumatic stress disorder (PTSD).

I had a really wonderful panel of speakers, including Dr Tom Neylan from the University of California, San Francisco, who gave an amazing talk on how much impact PTSD has on patients, their families, and on their occupational performance, and just the depth of how these symptoms related to having previously experienced a life-threatening trauma can impact and have very profound effects on people who have survived these kinds of life-threatening traumas.

That was followed by a wonderful talk by Susan Gurley, who is the executive director of the Anxiety and Depression Association of America. She is a staunch patient and family advocate, and her talk was beautiful: on looking at stigma as it relates to posttraumatic stress, stigma in society as well as self-stigma.

People who are recovering from posttraumatic stress carry around a lot of fear that they are going to be judged, marginalized, or even fired from a job. And this type of self-stigma is somewhat silent. Patients are afraid to talk about it with their friends or families, so it keeps some very isolated. We are hoping that that message gets out to have more public awareness and to help people be brave enough to seek treatment.

Now when it comes to treatment, we know that we have many things that are available, but they are not always as effective as we would like them to be. So, that is why we were so excited to have 2 speakers looking at some very new data on some treatment responses.

First of all, Dr Adriana Feder from the Icahn School of Medicine at Mount Sinai gave a wonderful talk on intravenous (IV) ketamine in combination with written exposure therapy.

She followed up on some randomized controlled trials that had been showing promise for IV ketamine. She had a small sample of women—this was an open-label study—but it is a promising pilot study. These women went through about 6 sessions of IV ketamine in combination with exposure therapy and really showed some profound improvement. Over half of those patients went on to be very responsive, and that response was sustained over a few months. So that is exciting and will be followed up on with more rigorous trials.

Our final session was very exciting, delivered by Saloni Behl from Otsuka Pharmaceuticals, and it was looking at 3 recent very large multi-site studies looking at brexpiprazole all in combination with sertraline. A little over 1200 individuals participated in these 3 large-scale studies, and it is just exciting. That brexpiprazole combined with sertraline came out to be much better than sertraline combined with placebo in 2 out of 3 of these studies. When you pull all the studies together, you still get this very important signal that the combination is superior to sertraline plus placebo.

So, that is exciting. It is on the horizon, and we can continue to look at these results. We also have posters on that study looking at the safety, which is very good, and tolerability of the brexpiprazole-sertraline combination.

I am just really excited that we are having some breakthroughs in this somewhat stagnant world of psychopharmacology—new and better treatments and combinations. This gives patients alternatives and, actually, hope that they can recover from a very devastating mental condition. We are just thrilled that we had this space in the ASCP Annual Meeting and hope you were there to see it. Thank you.

Dr Davis is a clinical professor of psychiatry in the Department of Psychiatry and Behavioral Neurobiology at the University of Alabama Health System in Birmingham and Tuscaloosa, Alabama.