Nightmare Disorders: Pharmacotherapy or Psychotherapy as The First Line Treatment?
Journal of Family Medicine and Preventive Medicine April 1, 2025 P. Liu
Nightmares are common, but only nightmare disorders require treatment. They can stem from PTSD, other psychiatric conditions, substance abuse, or individual predisposition. A literature review of eighteen pharmacotherapies and eleven psychotherapies for nightmare disorders was conducted to identify the best evidence-based options. For PTSD-related nightmare disorders, topiramate is recommended as first-line pharmacotherapy, nabilone as second-line, and cognitive behavior therapy, imagery rehearsal therapy (IRT), or exposure, relaxation, and rescripting therapy as appropriate psychotherapies. For non-PTSD nightmare disorders, triazolam or nitrazepam are first-line pharmacotherapies, and IRT is the psychotherapy of choice. Pharmacotherapy is prioritized over psychotherapy for PTSD-related cases; either can be first-line for non-PTSD cases.