Case report: Prazosin augmentation for treating comorbid treatment-resistant depression and chronic post-traumatic stress disorder

Abstract

Psychological trauma in childhood can lead to post-traumatic disorder (PTSD) with protracted comorbid depression, which responds poorly to conventional antidepressants. Previous studies have shown that prazosin, an α1-adrenergic receptor antagonist, can help eliminate nightmares and improve sleep quality and suicidal ideation in PTSD patients. This case report presents that prazosin had a rapid antidepressant effect in a female adolescent PTSD patient with treatment-resistant depression (TRD). Prazosin improved not only depression symptoms but also sleep quality, suicidal ideation, and cognitive function. Prazosin was well tolerated without obvious adverse effects. Our preliminary study suggests that further clinical trials are needed to determine the efficacy and safety of prazosin in treating PTSD patients with comorbid TRD.

Case series: Continued remission of PTSD symptoms after discontinuation of prazosin

“…In a systematic review of PTSD treatments by Martin et al, prazosin was noted to be first-line recommended treatment for PTSD-related nightmares in two guidelines, while other guidelines recommended it as third-line or provided no guidance at all (11). In addition, the effective dose of prazosin for nightmares tends to vary in case reports from 0.25 mg up to 50 mg daily (12,13). Recommendations based on guidelines suggest that prazosin be started at a low dose and titrated to an effective range of 3-16 mg/night (14); however, long-term efficacy has not been established.…”

Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review

“…Although the etiological mechanisms underlying PTSD or trauma-related depression are not known in detail, the efficacy of certain therapies may be indicative of existing pathomechanisms[ 62 ]. For example, in a case study, it was reported that low-dose prazosin led quickly to rapid improvement in depressive symptoms, including cognitive function in a therapy-resistant depressive patient with comorbid chronic PTSD[ 63 ]. The patient had previously received antidepressants that work via serotoninergic, noradrenergic, and dopaminergic mechanisms as well as several sessions of modified electroconvulsive therapy but did not benefit from these treatments, suggesting that prazosin may have acted by different pharmacological mechanisms from monoamine hypothesis[ 64 ].…”

Spectrum of the neuro-cardio-angiotropic and protector activity of the quinazoline and quinazolinone derivatives

“…Альфа1-адреноблокатор празозин с циклом хиназолина в структуре используется при лечении гипертензии, а также посттравматического стрессового расстройства с ночными кошмарами и/или расстройством сна, в том числе в педиатрической практике, оказывая антидепрессивное действие при резистентной к терапии депрессии, устраняя суицидальные мысли [55].…”