Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study

• Published in: Biological psychiatry (1969) 2008-03, Vol.63 (6), p.629-632
• Main Authors: Taylor, Fletcher B, Martin, Patti, Thompson, Charles, Williams, Judi, Mellman, Thomas A, Gross, Christopher, Peskind, Elaine R, Raskind, Murray A
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - adverse effects; Adrenergic alpha-Antagonists - therapeutic use; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Cross-Over Studies; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Dreams - drug effects; Female; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Nightmare; Polysomnography; Post-traumatic stress disorder; posttraumatic stress disorder; prazosin; Prazosin - adverse effects; Prazosin - therapeutic use; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; rapid eye movement sleep; Sleep - drug effects; sleep disturbance; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - psychology; Sleep, REM - drug effects; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - psychology; Wakefulness - drug effects
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2007.07.001

Background Prazosin, a central nervous system (CNS) active α-1 adrenoreceptor antagonist, has reduced nightmares and sleep disturbance in placebo-controlled studies of combat-related posttraumatic stress disorder (PTSD). We evaluated objective sleep parameters and PTSD symptoms in a placebo-controlled prazosin trial for civilian trauma-related PTSD. Methods Thirteen outpatients with chronic civilian trauma PTSD, frequent nightmares, and sleep disturbance participated in a randomized placebo-controlled crossover trial of prazosin. Sleep parameters were quantified at home with the REMView (Respironics, Pittsburgh, Pennsylvania). The PTSD symptoms were quantified with the Clinician Administered PTSD Scale (CAPS) “recurrent distressing dreams” and “disturbed sleep” items, a non-nightmare distressed awakenings scale, the PTSD Dream Rating Scale (PDRS), the PTSD Checklist-Civilian (PCL-C), and the Clinical Global Impression of Improvement (CGI-I). Results Prazosin compared with placebo significantly increased total sleep time by 94 min; increased rapid eye movement (REM) sleep time and mean REM period duration without altering sleep onset latency; significantly reduced trauma-related nightmares, distressed awakenings, and total PCL scores; significantly improved CGI-I scores; and changed PDRS scores toward normal dreaming. Conclusions Prazosin reductions of nighttime PTSD symptoms in civilian trauma PTSD are accompanied by increased total sleep time, REM sleep time, and mean REM period duration in the absence of a sedative-like effect on sleep onset latency.