Prazosin Helps People With PTSD Sleep
By Lorraine L. Janeczko
NEW YORK - Prazosin helps people with posttraumatic stress disorder (PTSD) sleep longer and more soundly, according to a new systematic review and meta-analysis.
"This study suggests that prazosin, a sympatholytic alpha-1 adrenergic receptor blocker, improves nightmares and overall PTSD symptoms, including hyperarousal, sleep disturbances, total sleep time, and sleep quality," Dr. Balwinder Singh, of the University of North Dakota School of Medicine and Health Sciences in Fargo, told Reuters Health by email.
"Prior reviews had shown that prazosin is beneficial for nightmares and may help sleep. Pooled data from our meta-analysis indicates that patients taking prazosin stayed asleep longer - 61 minutes - compared to placebo. The finding is significant, as the majority of sedative and hypnotic drugs have failed to show efficacy in this study population," Dr. Singh said in an email.
"The practicing physician may feel much more comfortable using prazosin and explaining the merits of this medication to their patients, leading to better and informed decision-making," he added.
Dr. Singh and his colleagues searched the major databases through August 2015 for randomized controlled trials comparing prazosin to a placebo or control group in patients with PTSD. From the 402 articles they screened, the researchers included six studies with 280 patients (80% male) with PTSD in the systematic review and 5 studies with 230 patients in the meta-analysis. They calculated standardized mean differences (SMDs) for each study, used a random effect model to calculate pooled SMDs, and Cochran's Q test and chi-square to assess heterogeneity.
As presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia, nightmares significantly improved (SMD 1.01), as did overall PTSD symptoms (SMD 0.77) and clinical global health (SMD 0.94), in patients who received prazosin compared to those in placebo/control groups.
Prazosin improved sleep quality (SMD 0.87), dream content, total sleep duration (mean difference 82.54 minutes), and hyperarousal symptoms (SMD 1.04). The drug somewhat helped patients who had difficulty falling or staying asleep, possibly due to the small number of studies.
Prazosin did not improve re-experiencing/intrusion and avoidance symptoms, the authors found no or minimal heterogeneity between the studies for most outcomes, and side effects were minor.
"PTSD is a debilitating illness," Dr. Singh said. "The cross-sectional studies of representative samples of U.S. adults have reported increasing lifetime prevalence of PTSD, ranging between 8.3% and 10.4%. Similarly, in a convenience sample of U.S. veterans, the prevalence was reported to be 30.5% for current diagnosis and 67.5% for lifetime diagnosis. PTSD not only affects the quality of life and causes its victims to incur financial burden, but it also makes them prone to depression, drug abuse, anger issues, marital discord, suicide attempts, and other physical and mental disabilities."
Dr. Singh and his coauthors plan to study the data on optimum dosage and usage of prazosin in patients with PTSD.
The authors reported no funding or disclosures
(c) Copyright Thomson Reuters 2016. Click For Restrictions - https://about.reuters.com/fulllegal.asp
