Best practice guide for the treatment of nightmare disorder in adults.
Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C. The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.
Aurora
R Nisha
RN
Mount Sinai Medical Center, New York, NY, USA.
Zak
Rochelle S
RS
Auerbach
Sanford H
SH
Casey
Kenneth R
KR
Chowdhuri
Susmita
S
Karippot
Anoop
A
Maganti
Rama K
RK
Ramar
Kannan
K
Kristo
David A
DA
Bista
Sabin R
SR
Lamm
Carin I
CI
Morgenthaler
Timothy I
TI
D000328:Adult; D003000:Clonidine / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D004325:Dreams / Q000187:drug effects / Q000523:psychology*; D019317:Evidence-Based Medicine; D057169:Eye Movement Desensitization Reprocessing; D006801:Humans; D006990:Hypnosis; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D011224:Prazosin / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy*
D011619:Psychotropic Drugs; D003000:Clonidine; D009638:Norepinephrine; D011224:Prazosin