Hello Everyone,
If you didn’t know I’m a military Veteran, USAF specifically and I’ve worked with many of my brothers and sisters in uniform suffering with PTSD. I have a strong interest in working with them when I finish my education. This week’s Journal club was very informative, and shocking as someone put in their post. Currently my clinical rotations are at Travis Air Force Base (AFB) and working in the Mental Health Clinic I see how often Prazosin is prescribed to patients with PTSD for nightmares, it’s prescribed almost every single time. So I too was shocked to find that this study conducted by the VA found that Prazosin is not effective at treating nightmares in patients with PTSD. I searched the internet and found some research opposing this articles research findings
Raskind (2018) states, “Prazosin is an inexpensive, clinically available and brain active drug that reduces brain noradrenergic activity by antagonizing the effects of norepinephrine at the postsynaptic alpha-1 adrenoreceptor”. By working on these receptors Prazosin has been proven to inhibit nightmares in individuals with PTSD. Prazosin should be initiated as an adjunctive treatment to promote sleep in those suffering from PTSD nightmares, and it should be started at 1mg and then titrated up until the absence or the desired reduction of nightmares is achieved, with a max dose recommendation of 20mg at bedtime (Breen, Blankley, & Fine (2017). According to Singh et al. (2016), the study found that prazosin improves nightmare symptoms and PTSD symptoms overall, including hyperarousal, other sleep disturbances, total sleep time, and the quality of sleep. From talking to my patients about how the medications are working for them in interviews I found that more patients feel that prazosin does help them sleep better and reduce the incidence of nightmares. In the end of the article we are responding to the authors stated that the study had some limitations, including the possibility of recruitment bias. I’m interested to read more research on the subject.
References
Breen, A., Blankley, K., & Fine, J. (2017). The efficacy of prazosin for the treatment of posttraumatic stress disorder nightmares in U.S. military veterans. Journal of the American Association of Nurse Practitioners, 29(2), 65-69. 10.1002/2327-6924.12432 Retrieved from https://ucsf.idm.oclc.org/login?url=http://dx.doi.org/10.1002/2327-6924.12432
Raskind, M. A. (2018). Pharmacology of sleep and PTSD: Prazosin - an alpha-1 adrenoreceptor antagonist approach to post-traumatic stress disorder pharmacotherapy. In E. Vermetten, A. Germain & T. C. Neylan (Eds.), Sleep and combat-related post traumatic stress disorder (pp. 349-359). New York, NY: Springer New York.10.1007/978-1-4939-7148-0_30 Retrieved from https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1007/978-1-4939-7148-0_30
Singh, B., Hughes, A. J., Mehta, G., Erwin, P. J., & Parsaik, A. K. (2016). Efficacy of prazosin in posttraumatic stress disorder: A systematic review and meta-analysis. LID - 10.4088/PCC.16r01943 doi]