Diane,
Your post resonates with me quite a bit. I too considered prazosin to be an effective treatment modality, and one that I had appreciated as being particularly effective for nightmares. To be fair, I came to this conclusion by observing others’ prescriptive recommendations during clinical rotations, and had not evaluated the literature on my own. That said, you make a really valid critique on the article, specifically around generalizing the results to the greater population with PTSD (beyond military veterans), as well as critique of the study design. Your post is a good reminder to evaluate all aspects of an article before making changes to one's practice.
Looking at other literature evaluating the efficacy of
prazosin specifically for military veterans and combat-related nightmares, a
systematic review (Breen, Blankley, & Fine, 2016) concluded that prazosin
is an effective adjunctive treatment for addressing nightmares and associated poor-quality
sleep, and has increased efficacy in those with more severe symptomology and suffering
specifically from trauma-related nightmares. Importantly, those with mild
symptoms are not recommended prazosin as it could delay the initiation of other
therapeutic approaches to address the trauma. Essentially, it seems as though evaluating
the severity of the symptoms and providing therapy is equally as important as
provided medication support.
References
Breen, A., Blankley, K., & Fine, J. (2016). The efficacy of prazosin for
the treatment of posttraumatic stress disorder nightmares in U.S. military
veterans. Journal
Raskind, M.A., Peskind, E.R., Chow, B., Harris, C., Davis-Karim, A., Homes, H.A….& Romesser, J. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507-517.