title: Prazosin for Veterans with Posttraumatic Stress Disorder and Comorbid Alcohol Dependence: A Clinical Trial.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is an important and timely clinical issue particularly for combat veterans. Few pharmacologic options are available to treat PTSD, particularly among military personnel, and they are not based on rational neurobiology. The evidence for noradrenergic dysregulation in PTSD is strong, and the alpha-adrenergic agonist prazosin is one of the most promising medications to treat sleep disturbances associated with PTSD as well as PTSD symptoms among both veterans and civilians. Evidence also implicates noradrenergic dysregulation in the pathophysiology of alcohol dependence (AD); prazosin also may have efficacy in treating this disorder. The use of prazosin represents a rational and compelling approach for the treatment of PTSD and comorbid AD. Given the high rates of comorbid AD in trauma survivors with PTSD, and the enormous impact that these comorbid disorders have on psychosocial function and well-being, finding effective treatments for this population is of high clinical importance.
  
  
  METHODS
  Ninety-six veterans with PTSD and comorbid AD were randomized to receive prazosin (16 mg) or placebo in an outpatient, randomized, double-blind, clinical trial for 13 weeks. Main outcomes included symptoms of PTSD, sleep disturbances, and alcohol use.
  
  
  RESULTS
  Symptoms of PTSD improved over time, but contrary to the hypothesis, there was no medication effect on PTSD symptoms, or on sleep. Alcohol consumption also decreased over time, but there were no significant differences in outcomes between medication groups.
  
  
  CONCLUSIONS
  Prazosin was not effective in treating PTSD symptoms, improving sleep, or reducing alcohol consumption overall in this dually diagnosed group. This does not support the use of prazosin in an actively drinking population and suggests that the presence of a comorbid condition affects the efficacy of this medication. This study highlights the importance of conducting clinical trials in "real-world" patients, as results may vary based on comorbid conditions.
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Ismene L
authors.initials: IL
authors.lastname: Petrakis
authors.affiliation: Bedford VA Medical Center, Bedford, Massachusetts.
authors.forename: Nitigna
authors.initials: N
authors.lastname: Desai
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Albert
authors.initials: A
authors.lastname: Arias
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Erin
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: J Serrita
authors.initials: JS
authors.lastname: Jane
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sevarino
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Steven
authors.initials: S
authors.lastname: Southwick
authors.affiliation: Department of Psychiatry, VISN I Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, Connecticut.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ralevski
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D000437:Alcoholism / Q000188:drug therapy* / Q000523:psychology; D017831:Diagnosis, Dual (Psychiatry); D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011224:Prazosin / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin
keywords: Alcoholism; Clinical Trial; Posttraumatic Stress Disorder; Prazosin; Veterans