The alpha1-Adrenergic Antagonist Prazosin Ameliorates Combat Trauma Nightmares in Veterans With Posttraumatic Stress Disorder: A Report of 4 Cases
J Clin Psychiatry 2000;61(2):129-134
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.