Cyproheptadine and PTSD?

[sunlioness]

Has anyone heard of any data to support using cyproheptadine (Periactin) to treat PTSD related hyperarousal sx? I'd never actually heard of it used for this until a doc who covers for us sometimes mentioned that he's had good success with it and now I'm curious.

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[Manicsleep]

Has anyone heard of any data to support using cyproheptadine (Periactin) to treat PTSD related hyperarousal sx? I'd never actually heard of it used for this until a doc who covers for us sometimes mentioned that he's had good success with it and now I'm curious.

Its an antihistamine. Does he say there is a reason its any better than vistaril or benadryl?

I prefer inderal and terazosin. Autonomic hyperarousal is usually SNS based, especially in the early stages.

 

[billypilgrim37]

What have been your experiences with terazosin? It's supposed to have minimal crossing of the blood-brain barrier. I've always been taught prazosin was the only alpha-blocker w/ any clinical value.

I believe the putative benefit in PTSD is through anti-5HT mechanisms, although being a strong antihistamine probably doesn't hurt.

 

[nitemagi]

I've only ever heard of it being used in serotonin syndrome for its anti-serotonin quality. Sadly this doesn't surprise me that there's evidence supporting use of a serotonin blocker in the setting where we always try to raise the serotonin level extremely high. Seems like we need these exceptions to break us out of buying that the serotonin hypothesis is any more than that - a hypothesis.

 

[Manicsleep]

Serotonin is also a stimulating NT. However, regarding the serotonergic blocking, its not all serotonin right, just certain receptors. Also, I think remeron has a similar effect?? I am only a superficial believer in prescription by NT.

The data is better with prazosin but I have seen both work to be honest.
The only reason I use terazosin over prazosin is longer halflife. Its not like the outcomes are markedly better with one vs another (in my experience). In acute states I get a lot of mileage from inderal.