Objective: To report the response to low-dose risperidone in individuals with combat-related post-traumatic stress disorder (PTSD) combat nightmares.
Design: Case series.
Setting: Veterans Affairs Medical Center Mental Health Clinic and collaborative VA-U.S. Army Fort Bragg Warrior Transition Telepsychiatry Clinic.
Practice description: Veterans at the VA; soldiers that have severe medical and mental health problems in the Warrior Transition Telepsychiatry Clinic.
Main outcome measure(s): No response: no change in frequency and/or severity of nightmares; partial response: decrease in frequency and/or severity of nightmares; full response: total cessation of recall of nightmares.
Results: The four individuals included one active duty soldier and three veterans, ranging from 40 to 76 years of age. All served in the infantry, each in a different combat theater. Two participants had a reduction in the frequency and severity of nightmares at risperidone 1 mg at night. One veteran with blood alcohol levels greater than 300 mg/mL had a partial response with risperidone 3 mg at night. Without active substance abuse, the four individuals had a total cessation of nightmares the first night at a risperidone dose of 2 mg at night. The total cessation of nightmares with risperidone continued despite changes in concurrent antidepressants, anxiolytics, and hypnotics. No medication side effects were reported.
Conclusion: The use of low-dose risperidone (1-3 mg) at night can reduce the severity and frequency or stop the recall of PTSD combat nightmares in some veterans and active duty soldiers. Risperidone may be an effective medication for combat nightmares of PTSD and merits additional exploration.