Objectives: In light of the high prevalence of sleep disorders in patients suffering from posttraumatic stress disorder (PTSD), this study sought to compare the effect of prazosin and hydroxyzine on sleep quality in this patient group. Methods: A total of 100 patients suffering from PTSD were assessed (mean age = 35.51 years, SD = 6.41; 28% females). Next, they were randomly assigned to one of three treatment groups: prazosin (33 patients), hydroxyzine (34 patients) or placebo (33 patients). The trial lasted for 8 weeks. The patients' sleep quality was assessed using the Pittsburgh Sleep Quality Index. Items taken from the Mini International Neuropsychiatric Interview were used to operationalize PTSD. Results: Compared to controls, patients treated with prazosin and hydroxyzine reported improved sleep and less nightmares. Improvement was greatest in patients treated with prazosin compared to hydroxyzine and placebo. Improvement in sleep was associated with an amelioration of their PTSD symptoms. Conclusion: Both prazosin and hydroxyzine can be used to treat psychopharmacological sleep disorders and nightmares in patients suffering from PTSD, also leading to reductions in PTSD symptoms.

Keywords:
Posttraumatic stress disorder, Placebo, Prazosin, Hydroxyzine, Sleep quality, Pittsburgh Sleep Quality Index
1.
Cirelli C, Tononi G, Pompeiano M, Pompeiano O, Gennari A: Anxiety disorders: posttraumatic stress disorder; in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), ed 4. Washington, American Psychiatric Association, 1994, pp 424-429.
2.
National Center for Post Traumatic Stress Disorder: What is PTSD? www. ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_faqs_on_ptsd.html (accessed Jan 10, 2012).
3.
Van Liempt S, Vermetten E, Geuze E, Westenberg HGM: Pharmacotherapy for disordered sleep in posttraumatic stress disorder: a systematic review. Int Clin Psychopharmacol 2006;21:193-202.
4.
Schoenfeld FB, Deviva JC, Manber R: Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev 2012;49:729-752.
5.
Sjöström N1, Hetta J, Waern M: Persistent nightmares are associated with repeat suicide attempt: a prospective study. Psychiatry Res 2009;170:208-211.
6.
Tanskanen A, Tuomilehto J, Viinamäki H, Vartiainen E, Lehtonen J, Puska P: Nightmares as predictors of suicide. Sleep 2001;24:844-847.
7.
Southwick SM, Krystal JH, Morgan CA, Johnson D, Nagy LM, Nicolaou A, et al: Abnormal noradrenergic function in posttraumatic stress disorder. Arch Gen Psychiatry 1993;50:266-274.
8.
Schnurr PP, Friedman MJ, Bernardy NC: Research on posttraumatic stress disorder: epidemiology, pathophysiology, and assessment. J Clin Psychol 2002;58:877-889.
9.
Daly CM, Doyle ME, Radkind M, Raskind E, Daniels C: Clinical case series: the use of prazosin for combat-related recurrent nightmares among Operation Iraqi Freedom combat veterans. Mil Med 2005;170:513-515.
10.
Taylor FT, Raskind MA: The α1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol 2002;22:82-85.
11.
Boehnlein JK1, Kinzie JD: Pharmacologic reduction of CNS noradrenergic activity in PTSD: the case for clonidine and prazosin. J Psychiatr Pract 2007;13:72-78.
12.
Menkes DB, Baraban JM, Aghajanian GK: Prazosin selectively antagonizes neuronal responses mediated by α1-adrenoceptors in brain. Naunyn Schmiedebergs Arch Pharmacol 1981;317:273-275.
13.
Taylor FB, Martin P, Thompson C, Williams J, Mellman TA, Gross C, Raskind MA: Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma PTSD: a placebo-controlled study. Biol Psychiatry 2008;63:629-632.
14.
Kung S, Espinel Z, Lapid MI: Treatment of nightmares with prazosin: a systematic review. Mayo Clin Proc 2012;87:890-900.
15.
Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, et al: A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbances in combat veterans with posttraumatic stress disorder. Biol Psychiatry 2007;61:928-934.
16.
Peskind ER, Bonner LT, Hoff DJ, et al: Prazosin reduces trauma-related nightmares in older men with chronic post-traumatic stress disorder. J Geriatr Psychiatry Neurol 2003;16:165-171.
17.
Guaiana G1, Barbui C, Cipriani A: Hydroxyzine for generalised anxiety disorder. Cochrane Database Syst Rev 2010;12:CD006815.
18.
Linden M, Bandelow B, Boerner RJ, Brasser M, Kasper S, Möller HJ, Pyrkosch L, Volz HP, Wittchen HU: The best next drug in the course of generalized anxiety disorders: the ‘PN-GAD-algorithm'. Int J Psychiatry Clin Pract 2013;17:78-89.
19.
Kubo N, Shirakawa O, Kuno T, Tanaka C: Antimuscarinic effects of antihistamines: quantitative evaluation by receptor-binding assay. Jpn J Pharmacol 1987;43:277-282.
20.
Barranco SF, Bridger W: Treatment of anxiety with oral hydroxyzine: an overview. Curr Ther Res 1977;22:217-227.
21.
Rothbaum BO, Stein, DJ, Hollander E: Textbook of Anxiety Disorders. Washington, American Psychiatric Publishing, 2009.
22.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text rev (DSMIV-TR). Washington, American Psychiatric Association, 2000.
23.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
24.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(suppl 20):22-33.
25.
Asadollahi GH, Ahmadzadeh GH, Mahmmudi-Gharaie J, Bashar Dost N, Faghihi T: The effect of prazosin on war post-traumatic stress disorders. Iran J Psychiatry 2003;8:1-4.
26.
Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, et al: Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:169-180.
27.
Escamilla M, LaVoy M, Moore BA, Krakow B: Management of post-traumatic nightmares: a review of pharmacologic and nonpharmacologic treatments since 2010. Curr Psychiatry Rep 2012;14:529-535.
28.
Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al: Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. J Psychosom Res 2012;72:89-96.
29.
Narimani M, Zahed A, Basharpoor S: Prevalence of posttraumatic stress disorder in hospital emergency nurses and fire department workers in Uremia city. Behav Sci Res 2010;8:69-74.
30.
Lee B, Youm Y: Social network effects on post-traumatic stress disorder (PTSD) in female North Korean immigrants. J Prev Med Public Health 2011;44:191-200.
31.
Fakour Y, Mahmoudi-gharaei J, Mohammadi MR, Karimi M, Azar M, Momtaz-bakhsh M: The effect of psychosocial supportive Interventions on PTSD symptoms after Bam earthquake. Tehran Univ Med J 2006;64:55-64.
32.
Magruder KM, Frueh BC, Knapp RG, Johnson MR, Vaughan JA 3rd, Carson TC, et al: PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. J Trauma Stress 2004;17:293-301.
33.
Fetzner MG, Abrams MP, Asmundson GJ: Symptoms of posttraumatic stress disorder and depression in relation to alcohol-use and alcohol-related problems among Canadian forces veterans. Can J Psychiatry 2013;58:417-425.
34.
Campbell DG, Felker BL, Liu CF, Yano EM, Kirchner JE, Chan D, et al: Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med 2007;22:711-718.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.