The Corpus Callosum

Drug for Nightmares?

Nightmares
are a terrible problem for many persons with posttraumatic stress
disorder.  Not only that, but they can be difficult to treat.
 

Lately, the LA Times has taken to emailing me a summary of some of
their Science & Medicine headlines.  I’m not sure why;
maybe the LA Times thinks the mighty prowess of ScienceBlogs will save
them from a corporate takeover somehow.  

Anyway, they did report one thing that I noticed and want to pass along:
href="http://www.latimes.com/news/science/la-sci-ptsd14apr14,1,2738769.story?coll=la-news-science">

href="http://www.latimes.com/news/science/la-sci-ptsd14apr14,1,2738769.story?coll=la-news-science">Drug
quiets war veterans’ sleep, study finds

The
hypertension medication prazosin appears to reduce nightmares and
improve rest in those with post-traumatic stress disorder.

By Thomas H.
Maugh II, Times Staff Writer

April 14, 2007

A
widely used hypertension drug improves sleep and reduces traumatic
nightmares in veterans with post-traumatic stress disorder, according
to federal researchers.

“This is the first drug that has been demonstrated effective for PTSD
nightmares and sleep disruption,” said the study’s leader, Dr. Murray
A. Raskind of the Veterans Affairs Puget Sound Health Care System in
Seattle.

“These nightmares are heavily troublesome to veterans,” he said. He
estimated that as many as half of the 10 million veterans and civilians
with PTSD had nightmares that could be helped by the drug, prazosin,
sold under the brand name Minipress…

Raskind and his colleagues enrolled 40 veterans; half received the drug
and half took a placebo for eight weeks.

The researchers will report Sunday in the journal Biological Psychiatry
that those receiving the drug experienced significantly improved sleep
quality, reduced traumatic nightmares, a better overall sense of
well-being and an improved ability to function…

Three larger studies of the drug are now beginning or underway.


It is a bit of a surprise that such a small study would get published,
then picked up by a major newspaper.  I mean, small studies
get published all the time, but they usually don’t get much attention.
 I suspect it is because the problem has been so difficult to
deal with, and perhaps because the proposed treatment is pretty simple
and safe.  Plus, PTSD in combat veterans is in the news, and
we will be hearing more about it the longer these wars we’re in go on.

What remains to be seen is how well this generalizes, whether it is
replicable, and whether the treatment effect holds up over time.
 Sleep has this way of reverting to its prior pattern, so I
would be concerned that the treatment effect could be lost over time.
 The study was only eight weeks: typical for a pilot study,
but not very convincing.

I don’t mean to be pessimistic.  It will be great if this
turns out to be a generally useful treatment.  My guess is
that it will turn out to be one of those 50:50 things, works for some,
not others, worth a try if the symptoms are bad enough, but with a need
to be cautious so you don’t go giving it to too many people.  

After all, that is where you run into trouble with off-label
prescribing.  Something gets to be a bit of a fad, everyone
gets on the bandwagon, and inevitably a few of those people have
problems.

Comments

  1. #1 stumpy
    April 17, 2007

    I’ve used periactin and Tenex for this indication, with variable results. Also clonidine. Wonder what dose of prazosin (Minipress) they used?

  2. #2 Dr. Deb
    April 17, 2007

    I need to read the study in detail. The small number concerns me as well.

  3. #3 Brandy
    September 19, 2008

    I am taking Prazosin for nightmares. It is prescribed through my VA medical center.

    Before, I would be awake at night, hypervigilant in a “can’t sleep, clowns will eat me” sort of way. I wouldn’t want to sleep at night because of the nightmares. Thankfully, my husband is really good at being able to waken and comfort me even in his sleep!

    Now, I CAN sleep at night. I don’t have disturbing dreams, and even when I am in the middle of a dream when I am awakened, it vanishes like a fog, and I awake feeling comparably refreshed. I only take 1 mg, and still have to watch out for postural hypotension, but that is the only “problem” I have with the drug. I get postural hypotension anyways, so it isn’t a huge problem for me.

    The doctor says they can raise my dose up to 4 or 5 mg if needed, but we’re taking it really slow as I’m on a ton of other meds already!

    At such low doses, it’s almost a “no harm, no foul” thing to try, if you can. It’s worth trying it to see if you can get a peaceful night’s sleep!

  4. #4 Joseph j7uy5
    September 21, 2008

    I don’t give medical advice on line, other than to make suggestions for things you might ask your doctor about. If you have postural hypotension, you might ask about taking salt tablets. Back when tricyclic antidepressants and MAOIs were used commonly, we used to see that problem, and would have people take salt tablets. It can cause hypertension so you have to keep an eye on it. But it is better than falling down all the time.