Posted by jrbecker on March 25, 2003, at 22:45:29
Alpha adrenergic antagonist tested for PTSD
http://manisses.com/2online/PUAlert/PA.html#clinical%20Updates
Researchers assessed the efficacy of prazosin (Minizide), a centrally-active alpha1 adrenergic antagonist used to treat hypertension, in 10 subjects with post-traumatic stress disorder (PTSD), with promising results. The 20-week trial was conducted using a double-blind, crossover design. The subjects were 10 male Vietnam combat veterans with chronic PTSD and severe trauma-related nightmares. Medications and psychotherapy ongoing at the point of entry into the study were continued; psychotropic medications included selective serotonin reuptake inhibitors (n=5), trazodone (n=2), benzodiazepines (n=4), anticonvulsants (n=2), hydroxyzine (n=2) and risperidone (n=1).
Subjects were randomly assigned to receive either prazosin or placebo. The dose was titrated for three weeks and maintained for six additional weeks, after which subjects underwent a two-week washout period before switching to the other treatment. The second treatment period also consisted of three weeks of titration followed by six weeks of maintenance. Subjects were rated on the Clinician-Administered PTSD Scale at baseline and endpoints and the Clinical Global Impression (CGI) of change was administered at the endpoints.
The primary outcome variables were the "recurrent distressing dreams" and "difficulty falling or staying asleep" items on the 17-item PTSD scale and the CGI. The researchers found significant improvement favoring prazosin treatment on both PTSD scale items (p<0.001 and p<0.01, respectively), as well as on the PTSD scale total score (p<0.01) and the CGI (p<0.01). They noted that the study drug was well tolerated; two patients experienced mild decreases in orthostatic systolic blood pressure which resolved as the dose was increased. The only study dropouts occurred among subjects in the second placebo group who experienced rapid return of distressing nightmares after discontinuing prazosin. Four subjects insisted on discontinuing the study in order to maintain treatment with prazosin.
The researchers conclude, "These results support the efficacy and safety of prazosin for trauma-related nightmares, sleep disturbance, and overall PTSD severity and function in previously treatment-resistant combat veterans."
Raskind MA, Peskind ER, Kanter ED, et al.: Reduction of nightmares and other PTSD symptoms in combat veterans by prozasin: a placebo-controlled study. Am J Psychiatry 2003; 160(2):371-373. Correspondence to: Dr. Raskind, VA Puget Sound Health Care System (116 MIRECC), 1660 S. Columbian Way, Seattle, WA 98108; e-mail: murray.raskind@med.va.gov.
poster:jrbecker
thread:212804
URL: http://www.dr-bob.org/babble/20030325/msgs/212804.html