Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study

Raskind, Murray A.; Peskind, Elaine R.; Kanter, Evan D.; Petrie, Eric C.; Radant, Allen D.; Thompson, Charles E.; Dobie, Dorcas J.; Hoff, David J.; Rein, Rebekah J.; Straits-Tröster, Kristy; Thomas, Ronald G.; McFall, Miles

doi:10.1176/appi.ajp.160.2.371

Cited by 536 publications

(339 citation statements)

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“…[48][49][50][51] There is substantial evidence to show that the sleep problems and nightmares that are seen in PTSD may be secondary to hyperactivity of the noradrenergic systems during the earlier acute stages of the trauma and thus prazosin, a selective a1 noradrenergic antagonist, was shown to provide clinical benefit. [52][53][54][55] Taken together, these findings suggest that traumatic stress results in a hyperactive central NE system and exaggerated central nervous system responses (i.e., sensitization) to noradrenergic activation. [48,49,56] …”

Section: Chronic Stress and Ne Activitymentioning

confidence: 83%

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

et al. 2010

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Norepinephrine (NE) is a major monoamine neurotransmitter that has widespread effects across multiple brain areas to regulate arousal and stress responses. The underlying function of the NE cortical system is to balance vigilance/scanning behavior with focused attention on novel environmental stimuli and the state of arousal. The central NE system is involved intrinsically with the stress response system, and dysregulation within the NE system has been implicated in the pathogenesis of anxiety and depressive disorders. Central NE activity paradoxically has either anxiogenic or anxiolytic effects, depending on whether the time course of the stress is acute or chronic, whether the stress is predictable or unpredictable, and which underlying brain regions are affected. Under conditions of chronic stress, NE system activity dysregulation of the hypothalamic-pituitary-adrenal system may turn a homeostatic stress response into a pathological stress response. Data suggest that the NE interplay with the serotonin system may exert neurobiological normalization of the pathophysiological state of anxious depression. Accordingly, pharmacological interventions targeting the NE system can result in anxiolytic, rather than anxiogenic, outcomes when used to treat patients with anxiety and depression. Depression and Anxiety 27:339-350, 2010. r r

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Section: Chronic Stress and Ne Activitymentioning

confidence: 83%

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

et al. 2010

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“…4,16,17 Patients in these 3 studies had a diagnosis of PTSD, with a CAPS minimum severity score for item B2, and active substance use within 3 to 6 months was excluded. Concurrent psychotropic medications were continued unchanged.…”

Section: Randomized Placebo-controlled Trialsmentioning

confidence: 99%

Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

252

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Nightmares, frequently associated with posttraumatic stress disorder and clinically relevant in today's world of violence, are difficult to treat, with few pharmacologic options. We performed a systematic review to evaluate the evidence for the use of prazosin in the treatment of nightmares. A comprehensive search was performed using the databases EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews, from their inception to March 9, 2012, using keywords prazosin and nightmares/PTSD or associated terms (see text). Two authors independently reviewed titles and abstracts and selected relevant studies. Descriptive data and outcomes of interest from eligible studies were extracted by 1 author, and checked by 2 others. The risk of bias of randomized controlled trials (RCTs) was assessed independently by 2 reviewers. Articles met criteria for inclusion if prazosin was used to treat nightmares, and outcome measures included nightmares or related symptoms of sleep disorders. Our search yielded 21 studies, consisting of 4 RCTs, 4 open-label studies, 4 retrospective chart reviews, and 9 single case reports. The prazosin dose ranged from 1 to 16 mg/d. Results were mixed for the 4 RCTs: 3 reported significant improvement in the number of nightmares, and 1 found no reduction in the number of nightmares. Reduced nightmare severity with use of prazosin was consistently reported in the open-label trials, retrospective chart reviews, and single case reports.

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“…Prazosin is a promising treatment for trauma nightmares and sleep disturbance in PTSD (14,15,16). However, prazosin effects on objective measures of sleep in PTSD have not been investigated.…”

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confidence: 99%

Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study

Taylor

Martin

Thompson

et al. 2008

Biological Psychiatry

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290

210

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Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study

Abstract: These data support the efficacy of prazosin for nightmares, sleep disturbance, and other PTSD symptoms.

Cited by 536 publications

References 14 publications

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

Treatment of Nightmares With Prazosin: A Systematic Review

Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study

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