Hello everyone,
Like many of my peers, I too was surprised and even shocked at the conclusion that prazosin was ineffective with veterans experiencing nightmares. I have completed two prior quarters at the SFVA and am now completing my residency there. Under the supervision of my preceptor, I have prescribed prazosin on three separate occasions. Each time they returned for a follow-up visit in as little as two weeks, they were excited that the intensity and length of their nightmares had decreased, and one said his had disappeared altogether within a two-week period. All three claimed that their PTSD symptoms were better in general, such as hypervigilance, irritability etc… I know that this does not make me an authority on the subject, so I asked some of my colleagues about their experience with prescribing prazosin. Out of the four MD.’s questioned with many years of experience, only one could remember two times where the drug was not effective. One time a patient ‘s B/P was too low, and the drug had to be discontinued. The other time was the patient had an allergic reaction to the medication.
One physician recalled having a patient that experienced PTSD symptoms so severely that he had to be placed on suicide watch. Shortly after starting him on this medication, not only did his night mares cease but he was able to be removed from the suicide watch. That veteran is working at the SFVA, in their community work program(CWP). I am sure more research should and is being conducted on this subject matter.
Great discussion and contribution from everyone, I really enjoyed it.