A pilot, randomized clinical trial of bedtime doses of prazosin versus placebo in suicidal posttraumatic stress disorder patients with nightmares

William Vaughn McCall, Anilkumar R Pillai, Doug Case, Laryssa McCloud, Tiffany Nolla, Fallon Branch, Nagy Adel Youssef, Jason Moraczewski, Liniya Tauhidul, Chirayukumar D Pandya, Peter B. Rosenquist

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose/Background Observational studies show an association between nightmares and suicide. Prazosin is proposed as a nightmare treatment. This pilot, randomized clinical trial tested whether treatment of nightmares with prazosin would reduce suicidal ideas in suicidal posttraumatic stress disorder (PTSD) patients. Methods/Procedures Twenty adult, suicidal PTSD patients with nightmares were blindly and randomly assigned 1:1 to escalating doses of prazosin versus placebo at bedtime only for 8 weeks. All participants had comorbid mood disorders and received stable doses of mood disorder medication. Outcomes of interest were measured weekly and included severity of suicidal ideation, nightmares, PTSD, insomnia, and depression. Longitudinal mixed-effects models assessed change in outcomes over time. Findings/Results All psychometric measures improved over 8 weeks. However, nighttime measures of nightmares and insomnia showed significantly less improvement in the prazosin group, whereas there was no significant change in daytime measures of suicidal ideation and daytime-only PTSD symptoms. Two patients required emergency psychiatric hospitalization, but there were no suicide attempts and no deaths. Implications/Conclusions This study confirmed an effect of nighttime-only prazosin on nighttime symptoms of insomnia and nightmares in suicidal PTSD patients who are experiencing nightmares. Surprisingly, the effect was in the direction opposite of what we expected. Furthermore, prazosin showed no signal on daytime measures including suicidal ideation. The results do not support a larger study of nighttime-only prazosin in suicidal PTSD patients but leave open the possibility of benefit from daytime administration of prazosin.

Original languageEnglish (US)
Pages (from-to)618-621
Number of pages4
JournalJournal of Clinical Psychopharmacology
Volume38
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Prazosin
Post-Traumatic Stress Disorders
Randomized Controlled Trials
Placebos
Suicidal Ideation
Sleep Initiation and Maintenance Disorders
Mood Disorders
Suicide
Psychometrics
Observational Studies
Psychiatry
Hospitalization
Emergencies
Depression
Therapeutics

Keywords

  • nightmares
  • posttraumatic stress disorder
  • prazosin
  • suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

A pilot, randomized clinical trial of bedtime doses of prazosin versus placebo in suicidal posttraumatic stress disorder patients with nightmares. / McCall, William Vaughn; Pillai, Anilkumar R; Case, Doug; McCloud, Laryssa; Nolla, Tiffany; Branch, Fallon; Youssef, Nagy Adel; Moraczewski, Jason; Tauhidul, Liniya; Pandya, Chirayukumar D; Rosenquist, Peter B.

In: Journal of Clinical Psychopharmacology, Vol. 38, No. 6, 01.12.2018, p. 618-621.

Research output: Contribution to journalArticle

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