Old Drug Brings New Promise for PTSD-related Nightmares

Every day, thousands of American service members relive the trauma of war in their sleep. They hear explosions, see the carnage of battle erupt around them and feel the crushing weight of a painful combat memory resurface in their dreams.

Unfortunately, frequent nightmares are common among service members with post-traumatic stress disorder. Moreover, they disrupt sleep, which can magnify the daytime symptoms of PTSD and stymie the recovery process significantly.

“Although psychotherapy is the best treatment for PTSD, it’s less impactful when a patient is tired, irritable, anxious or unable to concentrate because recurring nightmares continuously disrupt their sleep,” said Army Lt. Col. Jess Calohan, program director for the Psychiatric Mental Health Nurse Practitioner Program at the Daniel K. Inouye Graduate School of Nursing, part of the Uniformed Services University of the Health Sciences here.

In 2005, Calohan began working with Dr. Murray Raskind, who discovered that a largely obsolete blood pressure medication called prazosin appeared to be effective for treating PTSD-related nightmares. In his own practice, Raskind, director of the Northwest Network Mental Illness Research Education and Clinical Center at Veterans Affairs, used prazosin to treat Vietnam War veterans with PTSD.

Theoretically, the drug blocks the effects of adrenaline in areas of the brain thought to be responsible for causing nightmares during sleep. Raskind found that prazosin was tremendously successful at improving sleep quality and other PTSD-related symptoms.

Still, Raskind wondered if prazosin also would work on active duty service members. Their combat experiences were different, and they weren’t as far removed from the fight as the Vietnam War-era patients in his study.

Raskind, Calohan and colleagues partnered to investigate prazosin’s crossover efficacy. In two separate studies funded by the Veterans Affairs Department, active-duty soldiers with PTSD reported experiencing better, more restful sleep while taking prazosin. Furthermore, in many cases, the combat-related nightmares that amplified other PTSD symptoms were eliminated altogether. This led to vast improvements in overall PTSD treatment for the soldiers Calohan treated at Joint Base Lewis-McChord in Washington state and at frontline clinics in Iraq and Afghanistan.

“Before our research, prazosin was a level C on the strength of recommendation scale on the [VA and Defense Department] clinical practice guidelines, a system that measures the quality and consistency of evidence for using a medical intervention,” Calohan said. “Now, it’s a level B, but we fully expect prazosin will move up to a level A soon.”

Level A is the highest rating on the strength of recommendation scale. It’s reserved for interventions validated by high-quality, evidence-based studies. The team’s work is reaching for the top of the scale through research results and professional accolades. In fact, their study was the most-read article in last year’s September issue of the American Journal of Psychiatry. It also was lauded as the No. 1 innovation in psychiatry for 2013 by the New England Journal of Medicine.

In an effort to continue improving patient care, Calohan is using his expertise to shape the way rising military health care providers deliver care to service members with PTSD.

“Now that I’m here at USU, I’m able to review the prazosin literature and its application in clinical practice with my students,” he said. “It is definitely a good thing, because I’m educating providers about an effective method for treating sleep disturbances related to PTSD.”