23 “To die, to sleep – to sleep, perchance to dream..." Inhibition of Nightmares with Pramipexole: A Possible Treatment for PTSD
Freddy Escobar-Montealegre, P. Brar, A. Hirsch
CNS Spectrums February 1, 2019 DOI: 10.1017/s1092852919000178 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 60-year-old male with PTSD, trauma-related nightmares, and restless leg syndrome |
| Intervention | Pramipexole |
| Dose | 0.5 mg PO qHS; lower dose of 0.375 mg qHS |
| Topics | Dreaming PTSD |
| Key findings | In this case, pramipexole 0.5 mg at bedtime completely eliminated dreaming in a man with PTSD-related nightmares, with nightmares recurring after the drug was discontinued. A lower dose of 0.375 mg at bedtime controlled restless leg symptoms with better tolerance but did not prevent nightmare recurrence. The authors state that the mechanism for dream suppression is unclear and suggest further research on interventions targeting nightmares in PTSD. |
Abstract
Abstract Introduction The association of sleep disorders and post-traumatic stress disorder (PTSD) is almost universal. Nightmares are not only one of the most commonly associated but also featured as a diagnostic criterion for PTSD. PTSD-related nightmares are particularly distressing, may impair functioning and increase risk of suicide. No specific pharmacologic agent has been demonstrated to impair dreaming. Inhibition of PTSD-related nightmares with pramipexole has not heretofore been described. Such a case is presented.
Methods: Case study - This 60 year-old male with PTSD and trauma-related nightmares upon introduction of pramipexole 0.5mg PO qHS for Restless Leg Syndrome (RLS) had total elimination of dreams, which recurred upon discontinuation of this agent as a result of insomnia and increased anxiety. A lower dose of 0.375mg qHS provided optimal RLS-symptom control and overall improved tolerance despite nightmare recurrence.
Results: Abnormalities on Neurological examination: Recent recall: 2 of 4 objects without improvement with reinforcement. Able to spell the word “world” forwards but not backwards. Abstract thought impaired. Chemosensory testing: Anosmia and normogeusia. Motor: Drift: mild right pronator drift with right cerebellar spooning and right abductor digiti minimi sign. Reflexes: 3+ brachioradialis and biceps bilaterally, absent ankle jerks. Other: CT scan with and without contrast: normal.
Discussion: Nightmares related to PTSD may occur during Rapid Eye Movement (REM) sleep and non-REM sleep. Underlying sympathetic activation may lead to disruptive motor behavior similar to that seen in REM sleep behavior disorder. The exact mechanism of action by which inhibition of dreams occurred with use of pramipexole is unclear. Such a response is consistent with prior documented evidence of REM sleep suppression with low-dose pramipexole such as it‘s efficacy in reducing the intensity and frequency of nightmares and dream enactment related to REM sleep behavior disorder. Further research on therapeutic interventions that target nightmares directly may be beneficial for the management of patients with PTSD.
Comparable studies
Other case reports and case series on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. One couple with PTSD and a severe trauma history, participating in a pilot trial... | 2019 | Case study | n = 2 |
| Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD | 2022 | Retrospective case series | n = 35 |
| Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD | 2023 | Case series | n = 5 |
| Treatment of nightmares in the context of posttraumatic stress disorder A client with chronic, severe posttraumatic stress disorder (PTSD) | 2010 | Case study | n = 1 |
| 5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study 23-year-old female with chronic refractory PTSD | 2023 | Case study | n = 1 |