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Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans
Murray A Raskind1, Elaine R Peskind1, Bruce Chow1
1From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.).
Background:
In randomized trials, prazosin, an α1-adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans.
Methods:
We recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change).
Results:
A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo.
Conclusions:
In this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493 .).
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