Clinical Psychopharmacology and Neuroscience Papers in Press available online.

Quetiapine Treatment for Post-Traumatic Stress Disorder: a Systematic Review of the Literature
Calogero Crapanzano , Stefano Damiani , Ilaria Casolaro , Chiara Amendola
1Azienda Sanitaria Provinciale di Agrigento, CSM Licata, Licata, Italy, 2Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy, 3Azienda Socio Sanitaria Territoriale Ovest Milanese, Milano, Italy, 4Azienda USL Toscana Centro, CSM Scandicci, Firenze, Italy
Paroxetine and Sertraline are the only medications approved in posttraumatic stress disorder (PTSD). However, about 60% of traumatized patients fail to show an adequate clinical response. Second generation antipsychotics are recommended as second-line monotherapy or third-line augmentation strategies and quetiapine appears as one of the most used and promising agents. Up to date, no reviews assessed the efficacy of quetiapine in the treatment of PTSD. We aimed to assess the effectiveness and general safety of quetiapine on PTSD. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting studies that evaluated the efficacy of quetiapine on global or specific PTSD symptomatology. Ten studies (n = 894) were considered eligible for qualitative synthesis: one case report, one case series, one prospective cohort study, 3 open-label trials, 3 retrospective studies, one RCT. Quetiapine was effective on global PTSD symptomatology assessed in 6 studies as well as on re-experiencing (4/4 studies), avoidance (4/3 studies) and hyperarousal (4/4 studies), flashbacks (2/2 studies), depressive (4/4 studies), anxiety (1/1 studies), psychotic (3/3 studies), insomnia (4/5 studies), nightmares (3/3 studies) specific symptoms and PTSD domains. Sedation was among the most frequently observed adverse effects and the main cause of drug discontinuation. Preliminary findings support the efficacy of quetiapine in ameliorating symptoms relative to PTSD and its overall safety. However, quetiapine use in PTSD cannot be recommended yet as studies mainly rely on open-label, retrospective studies or case series.
Accepted Manuscript [Submitted on 2022-04-09, Accepted on 2022-06-20]