Wednesday, July 8, 2009

Prazosin and other treatments for PTSD-related nightmares

Nightmares are a common symptom of post-traumatic stress disorder (PTSD).

Various psychotherapeutic approaches can help people to deal with nightmares, both to be more psychologically prepared for them, and to be able to let them pass with a smaller amount of distress. Techniques include simply keeping a written record of the nightmares, with or without doing some cognitive therapy exercises based on this record; practicing relaxation techniques; exposure therapy during the daytime (by evoking the imagery of the nightmares, possibly "rescripting" the sequence of events); or by planning for a "rescripting" of the nightmare during the nightmare itself. Here is a reference to a review article about psychotherapy for nightmares:

Sedative drugs can change dreaming activity, but often times these medications are problematic: tolerance or oversedation may develop, or sometimes the nightmares continue despite other types of sleep improvement.

Prazosin is a cardiovascular drug which blocks alpha-receptors, and is commonly used to treat high blood pressure. Alpha receptors are stimulated by adrenaline, which causes constriction of blood vessels, therefore increased blood pressure. In the brain, increased stimulation of alpha-receptors may be one of the mechanisms driving PTSD-related sleep disturbances such as nightmares. Prazosin has been shown to help reduce PTSD-related nightmares. Here are a few references: {a good review article} {a 2007 randomized, controlled, crossover study published in Biological Psychiatry, showing pronounced reduction in PTSD-related nightmares with 10-15 mg bedtime doses of prazosin} {a 2003 randomized study published in The American Journal of Psychiatry showing substantial benefit in PTSD-related sleep symptoms with prazosin at an average of 10 mg/d}

There is the suggestion in these studies that prazosin, if dosed in the daytime as well, could help treat other PTSD symptoms.

Prazosin has been used for over 35 years in the treatment of hypertension. Interestingly, it is also one of the treatments of choice in the medical management of severe scorpion stings. It may also be a promising option in the treatment of alcoholism (reference:

Prazosin is well-tolerated by the majority of people taking it. It appears to have minimal psychiatric side-effects. Sedation does not seem to be common. If the dose is too high, too soon, it can cause excessive postural blood pressure drops, with dizziness and a risk of fainting (syncope). It may cause nasal congestion or headache. Priapism (a medically dangerous sexual side-effect) is possible but very rare.


Anonymous said...


I was wondering if you had any suggestions on working through maltreatment/abusive/PTSD related flashbacks while they are happening (ie: in the moment when you are conscious.)

Or how to weaken the connection between the flashback (that happened in the past) and your emotion (in the current environment).

Or how to stop re-experiencing the material of the particular flashback.

(I find that one flashback will elicit a certain emotional response which leaves me in a certain mood where I all remember is flashback material
the original flashback doesn't seem to go away. Almost like an obsessional thought.)

I guess I am looking for things that can help if I get caught off guard by a flashback when I am doing work so that I can get back to work again quickly.


GK said...

These are issues that could be discussed in a therapy setting, if it is your wish to do so.

Cognitive-behavioural ideas can be helpful, as can a mindfulness-style approach.

In the treatment of obsessional thoughts, and probably other types of intrusive thoughts as well, it can be helpful to develop a stance of letting the thoughts come, while not responding in any way behaviourally (including covert mental behaviours), other than perhaps acknowledging calmly to yourself something like, "oh, there's that intrusive thought again." Often times, intrusive thoughts are "fed" and exacerbated by attempts to suppress them, or by behaviours which suddenly alter the emotional or sensory environment (e.g. self-injury or substance use).

This can be a difficult problem, hard to tackle on your own. With a therapist, it can be a helpful structure to work through a PTSD workbook, at the pace that feels most comfortable to you.

Anonymous said...

Thought this would be of some interest.

These preliminary findings might provide further physiological correlates to gendered differences in externalization vs. internalization.

Ie-- that men experience emotion via more activation of their sympathetic nervous system compared to women.
(Women tend to externalize emotion more and display it on their face measured by the corrugator muscle tension using EMG. )

However, this may be a learned response due to cultural and societal display rules....

On the other hand the younger the child the higher the probability the difference may be due to sex rather than gender.


GK said...

Thanks, that's interesting. I'll look forward to learning more about this subject, starting with the reference you've given.
A phenomenon I've wondered about, I think which would be covered in the area of cultural psychology, is how different cultural groups (e.g. "eastern" vs. "western") display emotions differently (e.g. through more or less facial muscle activation); I wonder if this variable is even more pronounced than the gender/sex variable.