title: Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center.
abstract: The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0-6.0 mg), clonidine (63%, 0.1-2.0 mg), quetiapine (50%, 12.5-800.0 mg), mirtazapine (50%; 7.5-30.0 mg), and terazosin (64%, 50.0-300.0 mg). Notably, olanzapine (2.5-10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.
authors.affiliation: Staff Psychiatrist, Veterans Affairs Medical Center, Salem, VA 24153, USA. mark.detweiler1@va.gov.|Department Psychiatry, Edward via College of Osteopathic Medicine, Blacksburg, VA 24060, USA. mark.detweiler1@va.gov.|Virginia Tech-Carilion Clinic Psychiatry Residency Program, Roanoke, VA 24014, USA. mark.detweiler1@va.gov.|Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA. mark.detweiler1@va.gov.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Detweiler
authors.affiliation: Virginia Tech-Carilion Clinic Psychiatry Residency Program, Roanoke, VA 24014, USA. pagadala.bhuvaneshwar@gmail.com.
authors.forename: Bhuvaneshwar
authors.initials: B
authors.lastname: Pagadala
authors.affiliation: Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA. Joseph.Candelario@va.gov.|Emergency Department, Veterans Affairs Medical Center, Salem, VA 24153, USA. Joseph.Candelario@va.gov.
authors.forename: Joseph
authors.initials: J
authors.lastname: Candelario
authors.affiliation: Attending Physician, Veterans Affairs Medical Ce.nter, Syracuse, NY 13210, USA. Jennifer.Boyle2@va.gov.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Boyle
authors.affiliation: Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA. braciano@bellaltlantic.net.
authors.forename: Jonna G
authors.initials: JG
authors.lastname: Detweiler
authors.affiliation: Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA. blutgens@comcast.net.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Lutgens
keywords: combat; nightmares; pharmacotherapy; post-traumatic stress disorder; soldiers; veterans