Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder

Kirsten C. George, Lisa Kebejian, Leigh J. Ruth, Christopher W.T. Miller, Seth Himelhoch

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations

Abstract

Although sleep disturbances occur commonly in patients with posttraumatic stress disorder (PTSD) and are associated with adverse outcomes and increased suicidality, they are often inadequately addressed by antidepressant medications. Objective: This review aims to assess whether prazosin reduces nightmares, sleep disturbances, and illness severity in adults with PTSD. Method: Electronic databases (PubMed, PsycINFO) were searched in September 2014 for randomized controlled trials in adults. Search terms included posttraumatic stress disorder, prazosin, nightmares, and sleep disturbance. Included studies used prazosin and provided objective outcome data related to nightmares and/or sleep quality. Results: Six studies (191 participants) met the criteria for inclusion. Prazosin was more effective than placebo in improving nightmares (standardized mean difference [SMD] = 1.022, 95% confidence interval [CI] [0.41, 1.62], p = .001), sleep quality (SMD = 0.93, 95% CI [−0.02, 1.88], p = .054; and SMD = 1.14, 95% CI [0.24, 2.03], p = .01), and illness severity (SMD = 1.20, 95% CI [0.79, 1.61], p =.001, with no significant effect on systolic (SMD = −0.01, 95% CI [−0.40, 0.37], p = .94) or diastolic (SMD = 0.30, 95% CI [−0.09, 0.68], p = .154) blood pressure. Conclusion: PTSD-related nightmares, sleep disturbances, and overall illness severity showed a significant response to treatment with prazosin. With careful dose titration, prazosin was well tolerated and had no significant sustained effect on blood pressure.

Original languageEnglish
Pages (from-to)494-510
Number of pages17
JournalJournal of Trauma and Dissociation
Volume17
Issue number4
DOIs
StatePublished - Aug 7 2016

Bibliographical note

Publisher Copyright:
© 2016 Taylor & Francis.

Keywords

  • Nightmares
  • posttraumatic stress disorder
  • prazosin
  • sleep disturbance

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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