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In recent years, the understanding of the physiologic changes associated with combat related PTSD is growing. As Soldiers return from combat, rapid treatment, and promising medication is important. The introduction of Prazosin offers safer and outstanding results for treating the veterans with combat-related PTSD whose nightmares were reduced. Although preliminary evidence for the use of Prazosin for the management of combat-related PTSD appears promising, there seems to remain an urgent need for further research. The current climate of the United States in two wars, suggests that there be an ongoing effort to find new and effective medication interventions.
A variety of traditional agents have been used with questionable efficacy in treatment of PTSD patients. Such agents include anxiolytics, mood stabilizers, antidepressants, antipsychotics and adrenergic-receptor-inhibiting drugs. Selective serotonin reuptake inhibitors (SSRI) have been in use as a first line agent for treatment of PTSD. It is known to cause insomnia in a few patients. SSRI is known to have stimulating effects on sleep like increasing the number of arousals, suppressing REM sleep and decreasing total sleep time. Two SSRIs fluvoxamine and paroxetine have shown a small improvement in insomnia and among these two, only fluvoxamine has been describe as having effect on PTSD related nightmares. However use of fluvoxamine has been limited due to its drug-drug interaction. Antidepressants have also been used to treat PTSD and have shown significant effects in reducing nightmares and awakenings. They also improve the ability to fall asleep but despite these, they are used rarely because of the potential of hepatotoxicity and daytime sedation. Trazodone has been used as a first line agent in treatment of PTSD but it is associated with the risk of priapism which is a concern to male patients thus its use is limited. All the traditional agents have shown to have several side effects and cannot be fully relied on in treatment of PTSD.
Of all adrenergic-receptor- inhibiting agents, prazosin has the largest body data with regard to sleep disturbances. It is the most lipids soluble agent thus it enters the brain easily. It is relatively nonsedative and has been clinically available on a generic basis. Prazosin is orally active and has low effect on cardiac function because of its alpha-1receptor selectivity. After the use of the product among combat soldiers, there were notable positive changes which included a decrease from nightmares four to five nights a week. No patient deteriorated and no side effects were reported. According to Raskind, side effects that come along with use of prazosin can be managed and sustainable use can be for long as far as it’s used in the correct manner. Prazosin is known to cross the blood-brain barrier when taken orally. The optimal dosage has not yet been determined but it has been theorized that patients with recent traumas may respond to lower dosages than those with distant traumas.
Since 2005, soldiers in combat have been using prazosin for chronic PTSD and it has proved to be effective. However further studies should be carried out to determine whether prazosin would have the same effect on solders who are in hot and dehydrating areas. Most of the studies have been conducted in a combat setting thus it is important for further studies to be carried out to determine if prazosin would be effective in other settings. Further studies should be carried out to compare the efficacy of prazosin and SSRIs.
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