Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study

• Published in: The American journal of psychiatry 2003-02, Vol.160 (2), p.371-373
• Main Authors: Raskind, Murray A., Peskind, Elaine R., Kanter, Evan D., Petrie, Eric C., Radant, Allen, Thompson, Charles E., Dobie, Dorcas J., Hoff, David, Rein, Rebekah J., Straits-Tröster, Kristy, Thomas, Ronald G., McFall, Miles M.
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-agonists; Adrenergic alpha-Antagonists - therapeutic use; Biological and medical sciences; Chronic nightmares; Clinical trials; Combat Disorders - diagnosis; Combat Disorders - drug therapy; Combat Disorders - psychology; Combat related posttraumatic stress disorder; Cross-Over Studies; Double blind randomized controlled trials; Dreams - drug effects; Dreams - psychology; Drug therapy; Humans; Male; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Placebo effect; Placebos; Post traumatic stress disorder; Prazosin; Prazosin - therapeutic use; Psychiatric Status Rating Scales; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Sleep disorders; Sleep Wake Disorders - diagnosis; Sleep Wake Disorders - drug therapy; Sleep Wake Disorders - psychology; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - drug therapy; Stress Disorders, Post-Traumatic - psychology; Treatment; Treatment Outcome; Veterans; Veterans - psychology; Vietnam War
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.160.2.371

OBJECTIVE: Prazosin is a centrally active 1 adrenergic antagonist. The authors' goal was to evaluate prazosin efficacy for nightmares, sleep disturbance, and overall posttraumatic stress disorder (PTSD) in combat veterans. METHOD: Ten Vietnam combat veterans with chronic PTSD and severe trauma-related nightmares each received prazosin and placebo in a 20-week double-blind crossover protocol. RESULTS: Prazosin (mean dose=9.5 mg day at bedtime, SD=0.5) was superior to placebo for the three primary outcome measures: scores on the 1) recurrent distressing dreams item and the 2) difficulty falling staying asleep item of the Clinician-Administered PTSD Scale and 3) change in overall PTSD severity and functional status according to the Clinical Global Impression of change. Total score and symptom cluster scores for reexperiencing, avoidance numbing, and hyperarousal on the Clinician-Administered PTSD Scale also were significantly more improved in the prazosin condition, and prazosin was well tolerated. CONCLUSIONS: These data support the efficacy of prazosin for nightmares, sleep disturbance, and other PTSD symptoms.