The Effects of Pharmacological Treatment of Nightmares: A Systematic Literature Review and Meta-Analysis of Placebo-Controlled, Randomized Clinical Trials.
Mathilda Skeie-Larsen, Rebekka Stave, Janne Grønli, Bjørn Bjorvatn, Ane Wilhelmsen-Langeland, Amin Zandi, Ståle Pallesen
International Journal of Environmental Research and Public Health December 31, 2022 DOI: 10.3390/ijerph20010777 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Placebo-controlled Peer reviewed |
|---|---|
| Sample size | 830 |
| Population | People with nightmares, primarily veterans or soldiers with posttraumatic stress disorder |
| Interventions | Prazosin hydroxyzine clonazepam cyproheptadine nabilone doxazosin |
| Measures | Clinician-Administered PTSD Scale |
| Topics | Dreaming PTSD |
| Keywords | Humans Hydroxyzine Prazosin Dreams Stress disorders, post-traumatic Dronabinol Meta-analysis Rct Pharmacological intervention |
| Key findings | Across 14 placebo-controlled randomized trials, nightmare medications showed an overall effect size of Hedges' g = 0.50 (0.42 after adjustment for publication bias). Nabilone had the largest effect (g = 1.86, one study), followed by hydroxyzine (g = 1.17, one study) and prazosin (g = 0.54, 10 studies). |
Abstract
Nightmares are highly prevalent and distressing for the sufferer, which underlines the need for well-documented treatments. A comprehensive literature review and meta-analysis of the effects of different pharmacological placebo-controlled randomized clinical trials, covering the period up to 1 December 2022, was performed. Searches were conducted in PubMed, Embase, Web of Science, PsychInfo, Cinahl, and Google Scholar, resulting in the identification of 1762 articles, of which 14 met the inclusion criteria: pharmacological intervention of nightmares, based on a placebo-controlled randomized trial published in a European language, reporting outcomes either/or in terms of nightmare frequency, nightmare distress, or nightmare intensity, and reporting sufficient information enabling calculation of effect sizes. Most studies involved the effect of the α1-adrenergic antagonist prazosin in samples of veterans or soldiers suffering from posttraumatic stress disorder. Other medications used were hydroxyzine, clonazepam, cyproheptadine, nabilone, and doxazosin. The vast majority of studies were conducted in the USA. The studies comprised a total of 830 participants. The Clinician-Administered PTSD Scale was the most frequently used outcome measure. The results showed an overall effect size of Hedges' g = 0.50 (0.42 after adjustment for publication bias). The synthetic cannabinoid nabilone (one study) showed the highest effect size (g = 1.86), followed by the histamine H1-antagonist hydroxyzine (one study), and prazosin (10 studies), with effect sizes of g = 1.17 and g = 0.54, respectively. Findings and limitations are discussed, and recommendations for future studies are provided.
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 |
Citations in the library
Cited by 6
- Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders L'Encephale April 9, 2026
- A new insight into ayahuasca's adverse effects: Reanalysis and perspectives on its mediating role in mental health from the Global Ayahuasca Survey (GAS). PLOS mental health 2025
- Effects of Prazosin and Other Alpha-1 Adrenergic Antagonist Drugs on Nightmares and Sleep Disturbances in Posttraumatic Stress Disorder Journal of Clinical Psychopharmacology March 12, 2026
- Spanish Translation and Psychometric Evidence of the Nightmare Disorder Index (NDI) in Adults from the General Population European Journal of Investigation in Health, Psychology and Education October 27, 2025
- The effects of RBD medications on dream content: A critical review of evidence. Sleep Medicine October 21, 2025
and 1 more in the library
Cites 16
- Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Sleep 2002
- Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Sleep June 1, 2010
- Doxazosin for the treatment of nightmare disorder: A diary-based case study. SAGE open medical case reports 2020
- Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Current Psychiatry Reports October 11, 2018
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. Journal of Clinical Sleep Medicine June 15, 2018
and 11 more in the library