A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder

Biol Psychiatry. 2007 Apr 15;61(8):928-34. doi: 10.1016/j.biopsych.2006.06.032. Epub 2006 Oct 25.


Background: Excessive brain responsiveness to norepinephrine appears to contribute to post-traumatic stress disorder (PTSD), particularly at night. Prazosin, a brain active alpha-1 adrenergic receptor antagonist, significantly reduced trauma nightmares and sleep disturbance in 10 Vietnam War combat veterans in a previous placebo-controlled crossover study. The current parallel group trial in a larger sample of veterans evaluated prazosin effects on trauma nightmares, sleep quality, global clinical status, dream characteristics, and comorbid depression.

Methods: Forty veterans (mean age 56 +/- 9) with chronic PTSD and distressing trauma nightmares and sleep disturbance were randomized to evening prazosin (13.3 +/- 3 mg/day) or placebo for 8 weeks.

Results: In the evaluable sample (n = 34), primary outcome measures demonstrated that prazosin was significantly superior to placebo for reducing trauma nightmares and improving sleep quality and global clinical status with large effect sizes. Prazosin shifted dream characteristics from those typical of trauma-related nightmares toward those typical of normal dreams. Blood pressure changes from baseline to end study did not differ significantly between prazosin and placebo.

Conclusions: Prazosin is an effective and well-tolerated treatment for trauma nightmares, sleep disturbance and global clinical status in veterans with chronic PTSD.

Publication types

  • Evaluation Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use*
  • Aged
  • Blood Pressure / drug effects
  • Case-Control Studies
  • Combat Disorders / complications
  • Combat Disorders / drug therapy
  • Combat Disorders / psychology
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Dreams / drug effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prazosin / therapeutic use*
  • Psychiatric Status Rating Scales
  • Sleep Wake Disorders / drug therapy*
  • Sleep Wake Disorders / etiology
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / psychology
  • Treatment Outcome
  • Veterans*


  • Adrenergic alpha-Antagonists
  • Prazosin