Nightmare Disorders: Pharmacotherapy or Psychotherapy as The First Line Treatment?
Journal of Family Medicine and Preventive Medicine April 1, 2025 DOI: 10.47363/jfmpm/2025(2)106 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Interventions | topiramate nabilone triazolam nitrazepam cognitive behavior therapy imagery rehearsal therapy exposure relaxation and rescripting therapy |
| Topics | Dreaming |
| Keywords | Pharmacotherapy Psychotherapist Psychoanalysis |
| Key findings | For PTSD-related nightmare disorders, topiramate is recommended as first-line pharmacotherapy and cognitive behavior therapy, imagery rehearsal therapy, or exposure, relaxation, and rescripting therapy as appropriate psychotherapies; for non-PTSD nightmare disorders, triazolam or nitrazepam are first-line pharmacotherapies and imagery rehearsal therapy is the psychotherapy of choice. |
Abstract
Nightmares are almost an ubiquitous phenomenon but only nightmare disorders would need to be treated. Nightmare disorders result from a variety of causes including posttraumatic stress disorder (PTSD), psychiatric disorders, substance abuse, or idiosyncrasy. Nightmare disorders can be treated by either pharmacotherapy or psychotherapy. We performed literature search to explore eighteen possible pharmacotherapies and eleven possible psychotherapies for nightmare disorders to identify the best pharmacotherapy and psychotherapy through an evidence based approach. For PTSD-related nightmare disorders, topiramate as the first line and nabilone as the second line pharmacotherapy whereas cognitive behavior therapy, imagery rehearsal therapy (IRT), and exposure, relaxation, and rescripting therapy as the appropriate psychotherapies are recommended. For non-PTSD related nightmare disorders, triazolam or nitrazepam as the first line pharmacotherapy and IRT as the psychotherapy of choice are recommended. We then compared between all pharmacotherapies and psychotherapies to identify the best treatment for nightmare disorders in patients with and without post-traumatic stress disorder. For PTSD related nightmare disorders, pharmacotherapy is prioritized over psychotherapy. For non-PTSD related nightmare disorders, either pharmacotherapy or psychotherapy can be offered as the first line treatment.
Comparable studies
Other systematic reviews and meta-analyses on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. | 2013 | Systematic review with meta-analytic comparison | |
| Lucid dreaming incidence: A quality effects meta-analysis of 50 years of research | 2016 | Meta-analysis | |
| The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. Adults with chronic and recurring nightmares | 2023 | Systematic review | |
| The relationships between insomnia, nightmares, and dreams: A systematic review Individuals without a concomitant psychopathology, including those with insomnia or... | 2024 | Systematic review | |
| Psychosocial treatments for nightmares in adults and children: a systematic review | 2023 | Systematic review |