Prazosin appears to reduce nightmares, sleep disturbance, and other post-traumatic stress disorder (PTSD) symptoms in war veterans, study findings reveal.
Following positive results with prazosin, a centrally active α1 adrenergic antagonist, in reducing trauma-related nightmares in open label studies, Murray Raskind and colleagues assessed the efficacy of the drug in a placebo-controlled, crossover trial.
Over a 20-week period, 10 Vietnam combat veterans with chronic PTSD and severe trauma-related nightmares received 9.5 mg a day of prazosin, followed by a placebo for a further 20 weeks. After each treatment period, PTSD symptoms and functional status were assessed, using the Clinician-Administered PTSD Scale, and the Clinical Global Impression of Change.
Prazosin was superior to placebo in improving recurrent distressing dreams, difficulties in falling or staying asleep, and overall PTSD severity and functional status. When the patients were given prazosin, they also achieved better scores for re-experiencing/intrusion, numbing/avoidance, and hyperarousal than they did when taking placbo.
The researchers report that the drug's effectiveness stems from its ability to reduce light sleep and normalize rapid eye movement sleep, reducing the occurrence of nightmares. Prazosin also reduces secretion of the neuropeptide corticotropin-releasing hormone, which tends to be elevated in PTSD, and by inhibiting α1 regulation of the prefrontal cerebral cortex, the drug can correct disrupted cognitive processing and increased fear responses.
"Prazosin offers a novel and inexpensive approach to nightmare reduction and other PTSD symptom relief for combat veterans," says the team in the American Journal of Psychiatry.
"Further studies are necessary... to determine if prazosin is effective in civilian trauma PTSD."
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