The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases.

Abstract

BACKGROUND:

Central nervous system (CNS) adrenergic hyperresponsiveness may be involved in the pathophysiology of posttraumatic stress disorder (PTSD). Two Vietnam combat veterans with PTSD prescribed the centrally active alpha1-adrenergic antagonist prazosin for symptoms of benign prostatic hypertrophy unexpectedly reported elimination of combat trauma nightmares. This observation prompted an open-label feasibility trial of prazosin for combat trauma nightmares in chronic combat-induced PTSD.

METHOD:

Four consecutively identified combat veterans with chronic DSM-IV PTSD and severe intractable combat trauma nightmares participated in an 8-week open trial of escalating-dose prazosin. Nightmare severity response was rated using the nightmare item of the Clinician Administered PTSD Scale and the Clinical Global Impressions-Change scale.

RESULTS:

The 2 patients who achieved a daily prazosin dose of at least 5 mg were markedly improved, with complete elimination of trauma nightmares and resumption of normal dreaming. The 2 subjects limited to 2 mg of prazosin to avoid excessive blood pressure reduction were moderately improved with at least 50% reduction in nightmare severity.

CONCLUSION:

These clinical observations, together with neurobiological evidence for alpha1-adrenergic regulation of CNS neurobiological systems relevant to PTSD, provide rationale for placebo-controlled trials of prazosin for PTSD combat trauma nightmares.

• Authors: M A Raskind, D J Dobie, E D Kanter, E C Petrie, C E Thompson, E R Peskind
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 61 Issue 2 Pg. 129-33 (Feb 2000) ISSN: 0160-6689 [Print] United States
• PMID: 10732660 (Publication Type: Case Reports, Clinical Trial, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Adrenergic alpha-Antagonists
• Prazosin

Topics

• Adrenergic alpha-Antagonists (therapeutic use)
• Aged
• Ambulatory Care
• Chronic Disease
• Combat Disorders (drug therapy, epidemiology, psychology)
• Comorbidity
• Dreams (drug effects)
• Drug Administration Schedule
• Humans
• Male
• Middle Aged
• Prazosin (therapeutic use)
• Prostatic Hyperplasia (drug therapy, epidemiology)
• Psychiatric Status Rating Scales
• Severity of Illness Index
• Treatment Outcome