Terazosin for the Treatment of Trauma-Related Nightmares

Nirmalani-Gandhy, Anjali; Sanchez, Deborah L.; Catalano, Glenn

doi:10.1097/wnf.0000000000000077

Cited by 10 publications

(2 citation statements)

References 11 publications

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“…Terazosin is another α-1 adrenergic antagonist that has been reported to reduce nightmares associated with PTSD. 69 , 70 While terazosin did not achieve full recall cessation, reduction of symptoms was described on 64% of the trials with dose ranging between 2.0 and 5.0 mg. 71 Similarly, doxazosin (1.0–6.0 mg) has shown promise in PTSD nightmares. 72 , 73 Because of improved absorption profile and longer half-life and its availability as an extended release, doxazosin may offer significant advantages over prazosin in clinical practice.…”

Section: Approach To Managementmentioning

confidence: 98%

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

El-Solh

2018

NSS

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Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.

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Section: Approach To Managementmentioning

confidence: 98%

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

El-Solh

2018

NSS

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“…Nirmalani-Gandhy and colleagues have described the cases of four combat veterans (three men and one woman) with chronic PTSD who failed a prazosin trial, but who showed improvements in nightmares with terazosin, another alpha-1 noradrenergic antagonist [43]. Effective terazosin doses ranged between 2 mg titrated up to 10 mg.…”

Section: Alpha-1 Noradrenergic Antagonistsmentioning

confidence: 99%

Nightmares and Posttraumatic Stress Disorder (PTSD)

Campbell

Germain

2016

Curr Sleep Medicine Rep

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Nightmares are a unique feature of posttraumatic stress disorder (PTSD). Although nightmares are a symptom of PTSD, they have been shown to independently contribute to psychiatric distress and poor outcomes, including heightened suicidality and suicide. Nightmares are often resistant to recommended pharmacological or psychological PTSD treatments. Fortunately, nightmare-specific treatments are available, and improvements in nightmares are associated with clinically significant improvements in sleep quality and severity of daytime PTSD symptoms. The recent literature on the characteristics, neurophysiology, and treatment of nightmares in the context of PTSD is reviewed. Recent findings on the neurophysiological correlates of nightmares and more generally, dreaming, are also discussed here as they suggest novel directions for understanding the mechanisms underlying nightmares comorbid with PTSD and potential novel treatment approaches.

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