title: The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases.
abstract: BACKGROUND
  Central nervous system (CNS) adrenergic hyperresponsiveness may be involved in the pathophysiology of posttraumatic stress disorder (PTSD). Two Vietnam combat veterans with PTSD prescribed the centrally active alpha1-adrenergic antagonist prazosin for symptoms of benign prostatic hypertrophy unexpectedly reported elimination of combat trauma nightmares. This observation prompted an open-label feasibility trial of prazosin for combat trauma nightmares in chronic combat-induced PTSD.
  
  
  METHODS
  Four consecutively identified combat veterans with chronic DSM-IV PTSD and severe intractable combat trauma nightmares participated in an 8-week open trial of escalating-dose prazosin. Nightmare severity response was rated using the nightmare item of the Clinician Administered PTSD Scale and the Clinical Global Impressions-Change scale.
  
  
  RESULTS
  The 2 patients who achieved a daily prazosin dose of at least 5 mg were markedly improved, with complete elimination of trauma nightmares and resumption of normal dreaming. The 2 subjects limited to 2 mg of prazosin to avoid excessive blood pressure reduction were moderately improved with at least 50% reduction in nightmare severity.
  
  
  CONCLUSIONS
  These clinical observations, together with neurobiological evidence for alpha1-adrenergic regulation of CNS neurobiological systems relevant to PTSD, provide rationale for placebo-controlled trials of prazosin for PTSD combat trauma nightmares.
authors.affiliation: Department of Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center, University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, USA. raskind.murray@seattle.va.gov
authors.forename: M A
authors.initials: MA
authors.lastname: Raskind
authors.forename: D J
authors.initials: DJ
authors.lastname: Dobie
authors.forename: E D
authors.initials: ED
authors.lastname: Kanter
authors.forename: E C
authors.initials: EC
authors.lastname: Petrie
authors.forename: C E
authors.initials: CE
authors.lastname: Thompson
authors.forename: E R
authors.initials: ER
authors.lastname: Peskind
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000553:Ambulatory Care; D002908:Chronic Disease; D003130:Combat Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D004325:Dreams / Q000187:drug effects*; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D008875:Middle Aged; D011224:Prazosin / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D011224:Prazosin