A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.
BACKGROUND
Excessive brain responsiveness to norepinephrine appears to contribute to post-traumatic stress disorder (PTSD), particularly at night. Prazosin, a brain active alpha-1 adrenergic receptor antagonist, significantly reduced trauma nightmares and sleep disturbance in 10 Vietnam War combat veterans in a previous placebo-controlled crossover study. The current parallel group trial in a larger sample of veterans evaluated prazosin effects on trauma nightmares, sleep quality, global clinical status, dream characteristics, and comorbid depression.


METHODS
Forty veterans (mean age 56 +/- 9) with chronic PTSD and distressing trauma nightmares and sleep disturbance were randomized to evening prazosin (13.3 +/- 3 mg/day) or placebo for 8 weeks.


RESULTS
In the evaluable sample (n = 34), primary outcome measures demonstrated that prazosin was significantly superior to placebo for reducing trauma nightmares and improving sleep quality and global clinical status with large effect sizes. Prazosin shifted dream characteristics from those typical of trauma-related nightmares toward those typical of normal dreams. Blood pressure changes from baseline to end study did not differ significantly between prazosin and placebo.


CONCLUSIONS
Prazosin is an effective and well-tolerated treatment for trauma nightmares, sleep disturbance and global clinical status in veterans with chronic PTSD.
Raskind
Murray A
MA
Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), University of Washington, Seattle, Washington, USA. murray.raskind@med.va.gov
Peskind
Elaine R
ER
Hoff
David J
DJ
Hart
Kimberly L
KL
Holmes
Hollie A
HA
Warren
Daniel
D
Shofer
Jane
J
O'Connell
James
J
Taylor
Fletcher
F
Gross
Christopher
C
Rohde
Kirsten
K
McFall
Miles E
ME
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D003130:Combat Disorders / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004325:Dreams / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011224:Prazosin / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome; D014728:Veterans
D000317:Adrenergic alpha-Antagonists; D011224:Prazosin