Prazosin for Trauma Nightmares and Sleep Disturbances in Combat Veterans with Post-Traumatic Stress Disorder

Abstract

BackgroundPrazosin is significantly effective to reduce sleep disturbance and trauma nightmare in patients with post-traumatic stress disorder (PTSD); however, results of different studies were evaluated.ObjectivesThe current randomized clinical trial aimed to assess the effects of prazosin on sleep parameters and nightmares among veterans with chronic PTSD.Materials and MethodsThirty-two veterans with chronic war-induced PTSD and distressing nightmares were randomized into prazosin and placebo groups for eight weeks. The main symptoms were qualified using the recurrent distressing dreams item of the clinician administered PTSD scale (CAPS) and the daytime symptom severity was measured by PTSD checklist (PCL) and the objective sleep quality assessment by actigraphy.ResultsCompared with placebo, prazosin had no significant effects on reduction of daytime symptoms (P = 0.69) and frequency and intensity of trauma-related nightmares. Also, there were no significant differences between pre- and post-treatment actigraphy measurements (P > 0.05).ConclusionsThe study findings showed that prazosin had no significant effect on reduction of PTSD symptoms as well as nightmares among veterans with chronic PTSD. Further clinical trials are needed to define the effect of prazosin on sleep physiology and whether such effects regarding the therapeutic response.

Treatment Guidelines for PTSD: A Systematic Review

“…They did, however, highlight some important limitations, namely, small sample sizes and a lack of variability in both the research groups and participants, who were overwhelmingly male, combat veterans. Additionally, two more recent RCTs [ 49 , 50 ], not included in these meta-analyses, with relatively larger sample sizes, found no significant difference between prazosin and placebo in improving the CAPS distressing dreams item, or for any other primary outcome measures. While earlier positive trials for prazosin did not exclude participants with psychosocial instability, both negative studies excluded these patients.…”

Pharmacological management of post‐traumatic stress disorder and its associated nightmares: A survey of psychiatrists

“…While 13% reported they had no experience prescribing prazosin, 50% described it as potentially effective, and 35% described it as definitely effective in reducing nightmare frequency and/or severity. This is interesting in the context of the two most recent randomized controlled trials, which found no significant benefit for prazosin over placebo 29,30 . It is possible that patients seeking specialist psychiatric care for nightmares are more likely to be in the sub‐group of patients experiencing severe adrenergic dysfunction, for which prazosin is hypothesized to be more effective 31 .…”

“…Two more RCTs, 29,30 not included in these meta‐analyses, with sample sizes of 32 and 304, failed to find a significant difference between prazosin and placebo in improving the CAPS‐2 score, or for any other primary outcome measure. These discrepancies in results could perhaps be explained by differences in participants in the earlier positive trials compared with the newer negative trials.…”

“…These discrepancies in results could perhaps be explained by differences in participants in the earlier positive trials compared with the newer negative trials. The newer trials for prazosin had more restrictive exclusion criteria compared to the previous studies, so participants in the newer trials could be considered to be in a more stable condition 29–31 . It has been suggested that there may be a sub‐group of PTSD patients, with more severe adrenergic dysfunction, for whom prazosin is effective, that may have been excluded from the recent negative trials 29–31 .…”

The nexus between sleep disturbances and mental health outcomes in military staff: a systematic review

“…This has potentially exposed military staff at an increased risk for sleep predicaments compared to civilians 1 . They are several factors to justify sleep disturbances among military staff from which exposure to combat stress [2][3][4][5] , frequent shift work, frequent changes in duty assignments, and changes in duty station are more significant 6,7 . Inadequate sleep in military personnel is shown to hinder their operational readiness, effectiveness, and safety through impaired attention/concentration, judgment, responsiveness, and decision making as key substrates of their cognitive performance 8,9 .…”