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Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center.

Journal of Clinical Medicine December 16, 2016 DOI: 10.3390/jcm5120117 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Retrospective chart review Peer reviewed
Sample size 327
Population Veterans treated for PTSD nightmares at the Salem, VA Veterans Affairs Medical Center
Interventions Risperidone clonidine quetiapine mirtazapine terazosin olanzapine
Dose Risperidone 1.0-6.0 mg; clonidine 0.1-2.0 mg; quetiapine 12.5-800.0 mg; mirtazapine 7.5-30.0 mg; terazosin 50.0-300.0 mg; olanzapine 2.5-10.0 mg
Topics Dreaming PTSD
Key findings Among 478 medication trials for PTSD nightmares, risperidone (77%), terazosin (64%), clonidine (63%), quetiapine (50%), and mirtazapine (50%) each achieved partial to full nightmare cessation in more than half of trials, and olanzapine produced full remission in all five trials. The authors contend that risperidone, clonidine, terazosin, and olanzapine warrant further investigation in controlled trials.

Abstract

The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0-6.0 mg), clonidine (63%, 0.1-2.0 mg), quetiapine (50%, 12.5-800.0 mg), mirtazapine (50%; 7.5-30.0 mg), and terazosin (64%, 50.0-300.0 mg). Notably, olanzapine (2.5-10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.

Comparable studies

Other observational and cohort studies on PTSD, most cited first.

Study Year Design Participants
MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault 2008 Observational cohort n = 6
An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... 2017 Observational study using ambulatory polysomnography n = 35
Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares 2004 Observational cohort n = 44
Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs 2001 Observational study
Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD 2018 Retrospective review n = 37

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