The alpha1-Adrenergic Antagonist Prazosin Ameliorates Combat Trauma Nightmares in Veterans With Posttraumatic Stress Disorder

Raskind, Murray A.; Dobie, Dorcas J.; Kanter, Evan D.; Petrie, Eric C.; Thompson, Charles E.; Peskind, Elaine R.

doi:10.4088/jcp.v61n0208

Cited by 126 publications

(91 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Effective in DBPC study (C1) SSRI paroxetine Marshall et al 1998 Yes. Effective in DBPC studies (A) TCA desipramine Reist et al 1989 No ( Peskind et al 2003;Raskind et al 2000;Raskind et al 2002;Taylor and Raskind 2002 Only effective in nightmares (C1)…”

Section: (E)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

View full text Add to dashboard Cite

In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

show abstract

Section: (E)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

View full text Add to dashboard Cite

show abstract

“…[19][20][21][22] In the 3 older studies from 2000 to 2003, including 18 patients, participants had a diagnosis of PTSD with a minimum CAPS-B2 score, and active substance use within 3 to 6 months was excluded. [19][20][21] Seventeen of 18 patients (94.4%) experienced at least 50% reduction in occurrence of nightmares. Nightmare severity was reduced, in general, from a score of 6 to 8 to 0 to 3, and CGI-C showed markedly and moderate improvement in 17 of 18 patients.…”

Section: Open-label Trialsmentioning

confidence: 99%

Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

252

View full text Add to dashboard Cite

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.

show abstract

“…Alterations in noradrenergic signaling may underlie several affective disease states (Raskind et al, 2000;Stone et al, 2007). A single administration of cocaine elicits a transient increase in extracellular NE, while depression, anxiety and alcoholism are thought to involve more chronic alterations in adrenergic tone.…”

Section: A 1 -Ar Ltd Is Disrupted In Mice With Aberrant Noradrenergicmentioning

confidence: 99%

“…Raskind and colleagues reported that a 1 -AR antagonists are efficacious for patients with combat/noncombat induced post-traumatic stress disorder (Raskind et al, 2000Taylor and Raskind, 2002;Peskind et al, 2003;Taylor et al, 2006). Additionally, a 1 -AR antagonists are used to treat ailments like benign prostatic hypertrophy and hypertension and thus specific pharmacological agents are available for further investigation into their benefits in the treatment of affective disorders.…”

Section: Ne Induces Ltd In a Time-dependent Mannermentioning

confidence: 99%

α1-Adrenergic Receptor-Induced Heterosynaptic Long-Term Depression in the Bed Nucleus of the Stria Terminalis Is Disrupted in Mouse Models of Affective Disorders

McElligott

Winder

2007

Neuropsychopharmacol

View full text Add to dashboard Cite

The glutamatergic synapse in specific brain regions has been shown to be a site for convergence of stress and addictive substances. The bed nucleus of the stria terminalis (BNST), a nucleus that relays between higher order processing centers and classical reward and stress pathways, receives dense noradrenergic inputs that are known to influence behavioral paradigms of both anxiety and stress-induced relapse to drug seeking. a 1 -Adrenergic receptors (a 1 -ARs) within this region have been implicated in modulation of the HPA axis and anxiety responses. We found that application of an a 1 -AR agonist produced a long-term depression (LTD) of excitatory transmission in an acute mouse BNST slice preparation. This effect was mimicked by a 20 min, but not a 10 min, application of 100 mM norepinephrine (NE) in a prazosin-sensitive manner. This a 1 -AR LTD was independent of N-methyl-D-aspartate receptor (NMDAR) function unlike previously described a 1 -AR LTD in the hippocampus and visual cortex; however, it was dependent on the activation of L-type voltage gated calcium channels (VGCCs). In addition, a 1 -AR LTD was induced independently of the activation of mGluR5 which can also induce LTD in this region. Furthermore, a 1 -AR LTD was intact in mice receiving an intraperitoneal injection of cocaine but was disrupted in a 2a -AR and NE transporter (NET) knockout (KO) mice. Thus a loss of this plasticity at glutamatergic synapses in BNST could contribute to affective behavioral phenotypes of these mice.

show abstract

The alpha1-Adrenergic Antagonist Prazosin Ameliorates Combat Trauma Nightmares in Veterans With Posttraumatic Stress Disorder

Cited by 126 publications

References 0 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Treatment of Nightmares With Prazosin: A Systematic Review

α1-Adrenergic Receptor-Induced Heterosynaptic Long-Term Depression in the Bed Nucleus of the Stria Terminalis Is Disrupted in Mouse Models of Affective Disorders

Contact Info

Product

Resources

About