For sufferers of Post Traumatic Stress Disorder (PTSD), sleep disturbances are among the most treatment-resistant symptoms and can lead to drug and alcohol abuse and even suicide. Previously, there has been little success in treating these sleep disorders with psychopharmacologic approaches. In a study in the April 15th issue of Biological Psychiatry, researchers have found that an inexpensive, widely available drug was successful in reducing symptoms in chronic PTSD patients.
In a placebo-controlled, blinded study of 40 veterans of the Vietnam War (32 subjects), World War II (2), the Korean War (3), the Panama invasion (1) and the first Gulf War (2), prazosin was significantly more effective than placebo in reducing trauma nightmares, improving sleep quality and improving the general clinical condition of the treated patients.
Subjects were assessed using three primary outcome measures, the CAPS "recurrent distressing dreams" item, the Pittsburgh Sleep Quality Index (PSQI) and the Clinical Global Impression of Change (CGIC). The CAPS "recurrent distressing dreams" item measures frequency and intensity of trauma-related distressing dreams. The PSQI is a self-report scale assessing sleep quality and sleep disturbance. The CGIC is an investigator rated assessment of change in global clinical status, which was defined in this study as sense of well-being and ability to function in daily activities.
Improvements in all three measures were observed, with 71% of the subjects receiving prazosin having "moderately or markedly improved" CGIC scores at the end of the study, compared to 12% of those receiving placebo.
Writing in the article, Murray A. Raskind, MD, states, "These results support the therapeutic use of prazosin for PTSD in combat veterans who present with trauma nightmares and sleep disturbance. Clinical experience suggests that prazosin also is beneficial for PTSD trauma nightmares and sleep disturbance in young civilian trauma victims, young veterans of the current conflict in Iraq and Afghanistan and in elderly World War II and Korean War combat veterans and Holocaust survivors."
The article is "A Parallel Group Placebo Controlled Study of Prazosin for Trauma Nightmares and Sleep Disturbance in Combat Veterans with Posttraumatic Stress Disorder" by Murray A. Raskind, Elaine R. Peskind, David J. Hoff, Kimberly L. Hart, Hollie A. Holmes, Daniel Warren, Jane Shofer, James O'Connell, Fletcher Taylor, Christopher Gross, Kirsten Rohde, and Miles E. McFall. The authors are all from the Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington. The article appears in Biological Psychiatry, Volume 61, Issue 8 (April 15, 2007), published by Elsevier.
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