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Prazosin Reduces Trauma-Related Nightmares in Older Men with Chronic Posttraumatic Stress Disorder

Department of Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center, University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington

Lauren T. Bonner, MD

Department of Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center, University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington

David J. Hoff, PA-C

Department of Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center

Murray A. Raskind, MD

Department of Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center, University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington, murray.raskind{at}med.va.gov.

Trauma-related nightmares in posttraumatic stress disorder (PTSD) rarely respond to pharmacologic treatment. Neurobiologic data suggest that enhanced brain responsiveness to adrenergic stimulation may contribute to the pathophysiology of trauma-related nightmares in PTSD. Nine older men with chronic PTSD secondary to military or Holocaust trauma were prescribed the lipophilic alpha-1 adrenergic antagonist prazosin for treatment-resistant trauma-related nightmares. Prazosin 2 mg to 4 mg 1 hour before bedtime substantially reduced nightmares and moderately or markedly reduced overall PTSD severity in 8 of 9 subjects. Prazosin was well tolerated. These open-label results are consistent with demonstrated therapeutic efficacy of prazosin for PTSD nightmares and sleep disturbance in a recent placebo-controlled trial in Vietnam veterans. (J Geriatr Psychiatry Neurol 2003; 16:165-171).

Key Words: PTSD • prazosin • nightmares • veterans • Holocaust

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