PTSD drug making nightmares worse and suicide thought stronger?

Drug used for PTSD may worsen nightmares, not reduce suicidal thoughts

Medical Press
Medical College of Georgia at Augusta University
November 19, 2018

McCall reconfirmed in 2013 in The Journal of Clinical Sleep Medicine the link between insomnia and nightmares and how losing hope of ever getting another good night's sleep itself is a risk factor for suicide.

Nightmares and insomnia often accompany posttraumatic stress disorder and increase suicide risk.

Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia. Credit: Phil Jones, Senior Photographer, Augusta University

A small study looking at whether the drug prazosin, best known for treating high blood pressure but also used to treat PTSD-related sleep problems, can reduce suicidal thoughts has yielded surprising results.

They indicate it may actually worsen nightmares and insomnia and doesn't reduce suicidal thinking, investigators report in the Journal of Clinical Psychopharmacology.

"I think we have to view this as not the final word on this, but it raises questions," says Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University.

McCall is currently seeking input from PTSD experts across the country but says a likely consensus could be that prazosin may help some, but may not be a good choice when suicide is an active concern.

Two larger studies in active and retired military personnel yielded mixed results as well, the first in active duty military showed it helped with nightmares and sleep quality and a follow-up study just published this year on military veterans with chronic PTSD indicated it was no better than placebo.

McCall's pilot study is the first in which all participants had suicidal thoughts or actions.

"It did not seem to do much for suicidal ideation and that was somewhat disappointing, but the thing what was mind-blowing was that is actually worsened nightmares," says McCall. "Maybe it's not for everybody." He notes that with PTSD, a patient's nightmares often focus on the trauma that produced their disorder.
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