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Self-Assessment Questions

Psychiatry


Answer 4
  1. Add prazosin or clonidine to the treatment regimen. Adding prazosin (an α-adrenergic blocker) or clonidine (a centrally acting α-agonist) to an SSRI has been shown to reduce sleep disturbances (eg, nightmares) in patients with PTSD.11,12 The dose of SSRIs should be optimized to therapeutic level before adding another medication. If patients still experience nightmares, the addition of prazosin or clonidine may improve sleep and reduce the nightmares. Increasing the frequency of therapy sessions has not been shown to improve outcomes.9,10 Adding a ß blocker is helpful when hyperarousal symptoms such as tremors, sweating, and increased startle response are present.13

    REFERENCES
    9. Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2007;(3):CD003388.

    10. Sherman JJ. Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials. J Trauma Stress 1998;11:413–35.

    11. Krystal AD, Davidson JR. The use of prazosin for the treatment of trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry 2007;61:925–7.

    12. Boehnlein JK, Kinzie JD. Pharmacologic reduction of CNS noradrenergic activity in PTSD: the case for clonidine and prazosin. J Psychiatr Pract 2007;13:72–8.

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