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Prazosin for Military Combat-Related PTSD Nightmares: A Critical Review
Brian W. Writer, D.O.; Eric G. Meyer, M.D.; Jason E. Schillerstrom, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:24-33. doi:10.1176/appi.neuropsych.13010006
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Disclaimer: The opinions expressed on this document are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government.

From the Dept. of Psychiatry, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, TX.

Send correspondence to Dr Writer; e-mail: brian.writer@gmail.com

Copyright © 2014 by the American Psychiatric Association

Received January 15, 2013; Revised March 21, 2013; Accepted March 25, 2013.


Military combat is a common trauma experience associated with posttraumatic stress disorder (PTSD). Trauma-related nightmares are a hallmark symptom of PTSD. They can be resistant to label-pharmacological PTSD treatment, and they are associated with a variety of adverse health outcomes. The purpose of this article is to review and evaluate prazosin therapy for combat-related PTSD nightmares. Consistent with available literature for all-causes PTSD nightmares, prazosin is an effective off-label option for combat-related PTSD nightmares. Future trials may further instruct use in specific combat-exposure profiles.

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TABLE 1.Classification of Study Evidence28
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TABLE 2.Summary of Available Studies Examining Prazosin Efficacy for Military Combat-Related Nightmares
Table Footer Note

SD: standard deviation; ASD: Acute Stress Disorder; BSI: Behavioral Sleep Intervention; CAPS: Clinician-Administered Posttraumatic Stress Disorder Scale; CES: Combat Exposure Scale; CGI–C: Clinical Global Impression–Change; ISI: Insomnia Severity Index; NNDA: Non-Nightmare Distressed Awakenings; PghSD: Pittsburgh Sleep Diary; PSQI: Pittsburgh Sleep Quality Index; PSQI-A: PSQI Addendum for PTSD; SUD: Substance Use Disorder.

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TABLE 3.Common Primary Outcome Measures
Table Footer Note

CGI–C:32 1: markedly improved; 2: moderately improved; 3: minimally improved; 4: unchanged; 5: minimally worse; 6: moderately worse; 7: markedly worse.



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Prazosin for military combat-related PTSD nightmares: a critical review. J Neuropsychiatry Clin Neurosci 2014;26(1):24-33.