Hey Adrienne,
I too was shocked after reading the article for this week regarding that Prazosin did not help to reduce nightmares and improve sleep for combat war veterans (Raskind. et al, 2018). As everyone else who posted a response, I do not agree with this article, however, there is not that much information or research provided to conclude that Prazosin is ineffective. With all the research out there stating that it has been effective, and noticing improvement with patients who are currently taking the medication, leaves me to wonder why Prazosin isn't FDA approved for Nightmares related to PTSD (Stahl, & Muntner, 2014).
It is interesting to note, because all of the information and studies prove otherwise that Prazosin is effective in reducing nightmares, and sleep quality. Looking at UpToDate and other articles, it all reaches to the same conclusion, Prazosin is effective (Zak, & Karippot, 2017). I think during the discussion, Seth mentioned about the validity of the article and he brought up a good point. Because people may take this article by Raskind, and start taking their patients off Prazosin, despite previous research studies stating otherwise. I think we should look at the overall picture and see what is beneficial for them. Sometimes other medications like SSRIs/SNRIs may not help, so going outside the box might be necessary to help improve symptoms.
UpToDate also suggests that other forms of treatment management should be used, such as psychotherapy (Zak, & Karippot, 2017). I think the article we read this week had a lot of limitations and exclusion criteria. They excluded patients who were using Trazodone and other medications prior to the start of the clinical trials, etc (Raskind. et al, 2018). That is something to note as well in retrospect of the validity. Also, there could be a number of reasons why the FDA still hasn't approved Prazosin for labeled use of nightmares for PTSD (Loughlin, & Generali, 2007). More research needs to be conducts, with larger groups sizes, and with diverse population. However, until then, we should do what is best for the patient and treat accordingly.
This was an very interesting topic and discussion. Interesting to see what other articles we will discuss in the future.
Sarishma
References:
Loughlin, K., & Generali, J. (2007). Prescription drugs: alternative uses, alternative cures. New York: Pocket Books.
Raskind, M.A., Peskind, E.R., Chow, B., Harris, C., Davis-Karim, A., Holmes, H.A., Hart. K.L. et al, (2018) “Trail of Prazosin for PTSD in Military Veterans”, The New Englan Journal of Medicine. Vol 378(6) 507-517.
Stahl, S. M., & Muntner, N. (2014). Stahls essential psychopharmacology: prescribers guide. New York: Cambridge University Press.
Zak, R., & Karippot, A. (2017). Nightmares and nightmare disorder in adults. Retrieved March 02, 2018, from https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults?sectionName=Prazosin&anchor=H4261530858&source=see_link#H4261530858