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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by zonked on April 10, 2014, at 23:39:02
Hi,
I've been gone a lot. I've been fulltime caregiving for my mom, whose brain cancer has become inoperable and has occasional dementia (much better since on Namenda XR, FWIW)...
Has anyone taken prazosin for nightmares? I have PTSD on my diagnosis list now, although it looks a lot closer to C-PTSD which didn't make it into the DSM.
It seemed 1mg at bedtime of prazosin really like, took away the nightmares at first, but now I still have them, particularly towards waking.
What's the typical dose? Would increasing the dose help? Anyone taken an extended release version?
Other symptoms: Depression is so-so and anxiety is high. I think it's related to caregiving and moving back to an area of the country which trigger traumatic memories. Head STILL above water though.
-z
Posted by SLS on April 11, 2014, at 0:28:25
In reply to Prazosin for PTSD/nightmares anyone?, posted by zonked on April 10, 2014, at 23:39:02
Hi Zonked.
I am currently taking prazosin 30 mg/day for bipolar depression, possibly attributed, at least partially, to "developmental PTSD". With the exception of reduced libido, I experience no side effects. It feels like a very clean antidepressant. I've done some research on this drug, and I am convinced that:
1. Prazosin given at night treats nightmares and disrupted sleep due to PTSD.
2. Prazosin treats the daytime depression and anxiety associated with PTSD if dosed high enough 3 times a day.
3. The dosages of prazosin used in the treatment of PTSD have historically been too low. Some doctors are going to 40 mg/day.
If you are going to try prazosin, I recommend that you start with a single 1 mg dose at bedtime to avoid the initial dizziness and vertigo that usually occurs. You can then go to 3 mg at night for a few days before considering daytime dosing.
I'll try to answer any questions you may have.
- Scott
----------------------------------------------------
Ther Adv Psychopharmacol. 2014 Feb;4(1):43-47.
High-dose prazosin for the treatment of post-traumatic stress disorder.
Koola MM1, Varghese SP2, Fawcett JA3.
Author information
AbstractPatients with post-traumatic stress disorder (PTSD) are frequently symptomatic despite being on medications currently approved by the US Food and Drug Administration for PTSD. There is evidence to support the notion that prazosin is effective for PTSD nightmares. However, PTSD-related nightmares often do not resolve completely on a low dose of prazosin. The capacity of prazosin to treat daytime symptoms of PTSD which are distressing to patients has not been well studied. Clinicians are reluctant to increase the dose of prazosin due to side effect concerns. To date, the highest reported dose of prazosin used for PTSD is 16 mg daily. We illustrate two case reports using high-dose (up to 30 and 45 mg) prazosin for PTSD with comorbid treatment-resistant mood disorders. We report that high-dose prazosin was safe, tolerable and effective for PTSD in adults. To our knowledge, this is the first case series to highlight the importance of using high-dose prazosin for the treatment of PTSD. In patients with partial response to currently available medications for PTSD, greater utilization of high-dose prazosin for the management of PTSD may lead to better outcomes.
KEYWORDS:High dose prazosin, comorbid depression, post-traumatic stress disorder
- Scott
Posted by phidippus on April 11, 2014, at 16:38:23
In reply to Prazosin for PTSD/nightmares anyone?, posted by zonked on April 10, 2014, at 23:39:02
>What's the typical dose?
Around 10 mg.
>Would increasing the dose help?
Yes, you can go up to 20 mg.
Anyone taken an extended release version?
There is no extended release version.
Eric
ps - don't be afraid to take an antidepressant to help you cope with the temporary depression.
Posted by zonked on April 11, 2014, at 18:19:27
In reply to Re: Prazosin for PTSD/nightmares anyone? » zonked, posted by SLS on April 11, 2014, at 0:28:25
> Hi Zonked.
>
> I am currently taking prazosin 30 mg/day for bipolar depression, possibly attributed, at least partially, to "developmental PTSD". With the exception of reduced libido, I experience no side effects. It feels like a very clean antidepressant. I've done some research on this drug, and I am convinced that:
>
> 1. Prazosin given at night treats nightmares and disrupted sleep due to PTSD.
>
> 2. Prazosin treats the daytime depression and anxiety associated with PTSD if dosed high enough 3 times a day.
>
> 3. The dosages of prazosin used in the treatment of PTSD have historically been too low. Some doctors are going to 40 mg/day.
>
> If you are going to try prazosin, I recommend that you start with a single 1 mg dose at bedtime to avoid the initial dizziness and vertigo that usually occurs. You can then go to 3 mg at night for a few days before considering daytime dosing.
>
> I'll try to answer any questions you may have.
>
>
> - Scott
>
>Thank you sir! How are you doing/what are you taking these days? It's been about a year.
Me: Same ol Nardil 30mg t.i.d., Xanax 1mg b.i.d., ambien 10mg qhs + now prazosin 1mg qhs.
Will talk to new (back in California now) shrink after plan is effective May 1 about: Re-adding dexedrine or vyvanse, increasing prazosin, and anything else I can think of.
What's old is also new again: My mom drinks wine (she's on hospice, no one cares) but I find it hard to resist when she's drinking and I do not. I find that if I increase my Xanax a bit, I don't "want" it as much. The last time I was worried about my drinking was 2001-ish when my insurance ran out, and before I had it again, and I felt like booze kept me from .. doing the unthinkable.
Looking forward to going to inhome caregiver support groups + also restarting the stimulant - alcohol then seems anathema.
I do know if that if drinking becomes problematic, SMART recovery is around in the area - I am not a fan of 12-step.
Best,
GG
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