A drug sometimes used to treat PTSD could actually make symptoms worse, rather than better. Photo courtesy of The Marines/Flickr
THURSDAY, Dec. 27, 2018 -- A drug used to treat post-traumatic stress disorder may actually be harmful, a new study suggests.
The high blood pressure drug prazosin is sometimes used to treat PTSD-related nightmares and insomnia that can increase suicide risk. But this small study suggests the drug may make nightmares and insomnia worse and not reduce suicidal thoughts in PTSD patients.
"I think we have to view this as not the final word on this, but it raises questions," said study author Dr. W. Vaughn McCall. He's chairman of psychiatry and health behavior at the Medical College of Georgia.
The study included 20 PTSD patients, including two military veterans and several civilian women who had been sexually assaulted. All had active suicidal thoughts, some had previously attempted suicide, and most were taking antidepressants and/or had them prescribed for the study.
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For eight weeks, participants took prazosin at bedtime with an aim of preventing nightmares and suicidal thoughts. They were assessed weekly for severity of suicidal thoughts, nightmares, insomnia, depression and PTSD.
The drug "did not seem to do much for suicidal ideation and that was somewhat disappointing, but the thing what was mind-blowing was that it actually worsened nightmares," McCall said in a university news release. "Maybe it's not for everybody."
The unexpected increase in nightmares and insomnia might owe to the severity of a patient's PTSD or the once-a-day dose of prazosin, he said.
PTSD patients' nightmares often focus on the trauma that caused their PTSD, he said.
Two patients required emergency inpatient psychiatric care, but there were no suicide attempts or deaths during the study, which was published recently in the Journal of Clinical Psychopharmacology.
Prazosin may help some PSTD patients, but may not be a good choice when suicide is an active concern, according to McCall, who is now seeking input from PTSD experts across the United States
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Two larger studies in active and retired military personnel yielded mixed results as well, he noted.
"We need to reconcile how is it that we had 10 years of data saying prazosin is good for nightmares in PTSD, a big study this February indicating it has essentially no [effect] and now a smaller study showing it can worsen some aspects," McCall said. "We need to know what it all means."
The antidepressants sertraline (Zoloft) and paroxetine (Paxil) are the only U.S. Food and Drug Administration-approved PTSD drug therapies, he said, adding that neither is widely effective.
The U.S. National Institute of Mental Health has more on PTSD.
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JoanFoster on December 28th, 2018 at 15:19 UTC »
Personally, Prazosin has been a Godsend for myself, others not so much.
My doctor did one of the original studies on its use for PTSD. We've had long, very long, discussions on it. He says that is probably the hardest drug to dose correctly because it doesn't make sense. An 80 pound female may need a 16mg dose and a 380 pound male may need a 0.125mg dose. Sex, weight, age aren't factors in dosing... just the individual. Doses for the individuals can vary by a factor of 128!
Without it, I have extreme difficulty sleeping. But 2mg will have me sleeping 16 hours a night.
waywardandweird on December 28th, 2018 at 13:49 UTC »
As with any drug, making the condition worse is always a risk. Antidepressants may cause suicidal thoughts, my chemo gave me heart failure, antibiotics may cause life-threatening infections.
Personally, Prazosin saved my life. I hadn't slept properly in years due to severe PTSD, I was afraid to sleep because I knew what was waiting for me, and my nightmares were so bad when I did sleep that I would be crying and non-functional for most of the day. Now I remember I was having a nightmare, but it's just a feeling and not much else. Also, I don't wake up screaming every night and having to change the sheets because I managed to drench the bed with cold sweat.
thenewsreviewonline on December 28th, 2018 at 13:18 UTC »
TL;DR The study included 20 adults with suicidal PTSD and nightmares randomised to prazosin (n=10) and placebo (n=10). The authors note the high clinical acuity and complex psychopharmacology in the study is a strength because it mirrors clinical practice and a weakness because it may weaken the signal-to-noise ratio in detecting a treatment effect. The authors make no claim or suggestion that prazosin is/was ‘harmful’ however highlight the need for further research to determine the most appropriate treatments/regimens.
Link: https://journals.lww.com/psychopharmacology/Abstract/2018/12000/A_Pilot,_Randomized_Clinical_Trial_of_Bedtime.15.aspx (Last accessed 28th Dec 2018)