Just like the majority, I, too, was very surprised regarding the low efficacy of prazosin stipulated in the article discussed. We are taught regarding this medication and for its treatment for PTSD associated nightmares and then the article says otherwise. I'm a bit in disbelief. A number of my patients who have been taking prazosin reports significant amount of improvement with nightmares with only taking 1-2mg. Last week, I treated a patient who was has been taking prazosin 6mg for 2 years with good response. Patients have said that the medication has truly helped them sleep better and either eradicate or lessen the frequency of nightmares experienced.
The article "What role do nightmares play in suicide? A brief exploration" explains prazosin as a treatment for PTSD nightmares with the greatest empirical evidence. However, when prazosin was discontinued, the return of nightmares can occur. Furthermore, in regards to nightmares and suicide, I can only imagine what a person who is re-experiencing his/her trauma and having a co-morbid disorder of depression, anxiety, or a mood disorder is going through. I have seen some who has PTSD and describe and interpret their nightmares/flashbacks as hallucinations. I wonder if that can be a predicament of suicidality, such as a high prevalence of those diagnosed with schizophrenia and a high rate of suicide. I would really like to see further studies in regards to the relationship between suicide and nightmares.
Reference
Titus, C.E., Speed, K.J., Cartwright, P.M., Drapeau, C.W., Heo, Y., & Nadorff, M.R. (2018). What role do nightmares play in suicide? A brief exploration. Current Opinion in Psychology, 22, 59-62. Retrieved from http://dx.doi.org/doi:10.1016/j.copsyc.2017.08.022