Quetiapine Augmentation for Treatment-resistant PTSD

Inclusion Criteria: Veteran age 18 to 75. Competent to give informed consent. Meeting DSM-IV criteria for PTSD. Minimal CAPS score of 50 at baseline. If female of childbearing potential, patient must have a negative pregnancy test and, if sexually active, be using a medically approved contraceptive method. Patients who have not taken psychiatric medications within 1 week prior to study entry (except fluoxetine [5 weeks]) monoamine oxidase inhibitors (MAOIs [4 weeks]) depot neuroleptics [4 weeks]) or any investigational drug within 30 days prior to study enrollment. To be eligible for Phase II patients must be refractory to paroxetine in Phase I, as defined by less than 30% reduction in CAPS scores or a minimum CAPS score of 50 at week 8 must have PTSD symptoms at least moderate severity on CGI-S and must have been compliant with study medicine in Phase I, as defined by taking at least 80% of prescribed doses. Exclusion Criteria: History of sensitivity to paroxetine or quetiapine. Failure to respond to a prior adequate therapeutic trial i.e. minimum of 8 weeks at maximum tolerated dose of paroxetine (up to 60 mg daily) or quetiapine (up to 800 mg daily). Women who are breast-feeding pregnant expect to become pregnant during the course of the study or are sexually active and are not using a medically acceptable method of birth control. Presence of clinically significant hepatic cardiovascular or other medical conditions that may prevent safe administration of paroxetine or quetiapine or any other clinically significant unstable medical conditions.