The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases.
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.
Raskind
M A
MA
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
Dobie
D J
DJ
Kanter
E D
ED
Petrie
E C
EC
Thompson
C E
CE
Peskind
E R
ER
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
D000317:Adrenergic alpha-Antagonists; D011224:Prazosin