Pharmacological Treatments

Providers also can use pharmacological treatments that providers can use to help patients, such as prazosin, speakers noted.

Murray Raskind, MD, director of the VA Northwest Network Mental Illness Research, Education and Clinical Center and professor and vice chair of the Department of Psychiatry and Behavioral Sciences of the University of Washington School of Medicine, discussed the use of prazosin as a treatment for PTSD.

Registered sleep scorer Ana Diaz analyzes and monitors a sleep study of a patient who has sleep apnea at the Walter Reed National Military Medical Center in Bethesda, Md. Photo from National Capital Region Medical website.

“It does not help one get to sleep. It doesn’t make one feel tired. But when one achieves sleep and has sleep disruption, with or without trauma-related nightmares, prazosin reduces those. It normalizes sleep and extends sleep throughout the night,” he said during the webinar.

Raskind, who noted that prazosin was originally introduced in 1973 for the treatment of hypertension, recounted that he was caring for Vietnam veterans as part of the VA Puget Sound African-American Veterans Group, when he discovered the drug could be use for patients with sleep disruptions.

“Working with these veterans, it became clear that their major complaint was, ‘I can’t sleep.’ The drug they were using most … to achieve a few hours of sleep was alcohol.”

He said that he originally gave propranolol to the first veteran he treated for severe, treatment-resistant, Vietnam-combat PTSD nightmares in 1996, after he read a case report suggesting its benefit. After two weeks, he recalled, the veteran said, “Doc, we are going the wrong direction. My nightmares are even worse.”

Raskind said he had not realized it at the time but learned that intensifying dreams is an established adverse effect of beta-adrenergic blockade. That caused him to question whether blocking brain alpha-1 adrenergic receptors with prazosin would suppress nightmares.

 After two weeks of a gradual prazosin dose increase in his veteran patient, the nightmares disappeared. He said this veteran continues to be nightmare-free — and alcohol-free—for the past 12 years and that similar long-term benefits have occurred in many other veterans using the medication.  

Raskind said he and his colleagues evaluated the effects of bedtime prazosin, versus a placebo, on sleep physiology and PTSD symptoms in 13 civilian trauma PTSD subjects with persistent trauma nightmares and sleep disturbance. In that study, researchers found that REM sleep time and total sleep time increased for the patients. Additional prazosin studies are ongoing, he said.¹

Raskind cautioned that prazosin is “not a cure. No drug is 100% for any condition,” he added.

Prazosin must be taken every night, because nightmares usually return for patients soon after it is discontinued, usually one to two days. Still, he said that, although modest dose increases are sometimes necessary over years of treatment, loss of efficacy is rarely observed.

1.  Taylor FB, Martin P, Thompson C, Williams J, Mellman TA, Gross C, Peskind ER, Raskind MA. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. BiolPsychiatry. 2008 Mar 15;63(6):629-32. Epub 2007 Sep 14. PubMed PMID: 17868655;PubMed Central PMCID: PMC2350188.

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