Prazosin

Prazosin

by Robert -
Number of replies: 1

I enjoyed this week’s topic regarding the use of prazosin in military veterans. I was surprised by the results of the study which indicated that it was ineffective with this particular group according the study’s results. Like many new mental health providers, I don’t have much experience with prescribing this medication for nightmares with individuals experiencing PTSD. With that said, like another student had pointed out during the discussion that we are taught that prazosin is the “go to” drug for patients who experience nightmares. I appreciate having that insight when caring for patients with nightmares, however it also makes me question its efficacy.

            It was interesting to hear that it has worked really well for some students in their experiences. I guess if I was in a situation where my patients were experiencing nightmares, I would have this study in the back of my mind when it comes to making decisions. It would be helpful if the patient has had used the medication in the past and if it was effective, if it was then it would be a fairly easy decision in terms of prescribing it. However, we also discussed that the study only looked at military veterans that were primarily male. This doesn’t account for large diverse female populations or even civilians.

            When it comes to patients that experience nightmares, it makes me think about their quality of sleep or lack thereof. I find myself thinking about how much this can impact their mood and contribute to their depressive symptoms. Knowing that prazosin did not help specifically with military veterans, I would still be inclined to prescribe this medication for patients. I would trial and educate the patient regarding this medication and its possible side effects, if it doesn’t work for them then at least we knew that we tried. If it does work then I would feel better about helping them have better sleep which might help alleviate their depressive symptoms.


In reply to Robert

Re: Prazosin

by Dale Wong -

Hi Rob,

Based on my clinical experiences, Prazosin is highly prescribed and recommended for those suffering from PTSD and recurring nightmares. The article posted for this discussion did highlight the fact that it wasn't effective in treating this condition; however, as you've stated, there exists the need for other populations to be examined as this was a primarily military-dominated research study. You mentioned that sleep is such an integral component pertaining to mood. Addressing this component can alleviate depressive symptoms and perhaps perhaps impact one's mood. At least with the PTSD patients that I see, many of them complain of lack of sleep or lack of quality sleep. This is definitely something to look into.

According to one research article I found, it outlined some of the key aspects pertaining to the results. It revealed that based on the veteran population studied, Prazosin was effective for trauma-related nightmares and sleep disturbances compared to the placebo (Raskind et al., 2003). Additionally, the use of the medication as a cost-effective measure should also be considered compared to expensive alternatives. However, the study did concede to the point that civilian trauma PTSD would need further research.

Raskind, M. A., Peskind, E. R., Kanter, E. D., Petrie, E. C., Radant, A., Thompson, C. E., … McFall, M. M. (2003). Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: A placebo-controlled study. American Journal of Psychiatry, 160(2), 371-373. doi:10.1176/appi.ajp.160.2.371