Murray A. Raskind, M.D.; Madigan Army Medical Center; PRMRP Investigator-Initiated Research Award

In post-traumatic stress disorder and in combat operational stress, the major symptoms or at least some of the most important symptoms occur at night. Specifically distressing recurring dreams or nightmares about traumatic situations encountered in combat and sleep disruption making it unable to achieve a restful night's sleep. And these two problems result in difficulty functioning during the day and a sense of marked distress not only at night but during the waking hours. We demonstrated earlier that a drug called prazosin, which is able to block the excessive brain response to the alerting neurotransmitter adrenaline, is highly effective compared to placebo for nightmares, sleep disruption and other post-traumatic stress disorders symptoms in veterans of the Vietnam War who are still having these symptoms many decades later. Prazosin is the only medication that has been demonstrated more effective than placebo for post-traumatic stress disorder, nightmares, and sleep disruptions. No other medication has been demonstrated affective even the FDA approved SSRI anti-depressants are not helpful for nightmares and sleep disruption. And in fact in Vietnam veterans, the SSRI anti-depressants actually have not been demonstrated more effective than placebo for any of the symptoms of post-traumatic stress disorder. Based on this finding Jess Calohan, our collaborator, was deployed to Iraq as the leader of a combat stress control team. He was faced with Warfighters who were coming to him for relief from severe trauma-related nightmares that were making impossible for them to achieve any kind of restful sleep and they were unable to function well during the day. Major Calohan, who was familiar with the effectiveness of prazosin in this older population and because prazosin is a generic and clinically available medication, he was able to use it in a similar matter. And prazosin markedly reduced nightmares, dramatically increased their ability to sleep and this resulted in increased sense of well-being and ability to function in the combat theater. When you get sleep under control and the nightmares are eliminated, you also eliminate suicidal ideation-often when it's present- and eliminate the drive for soldiers and other service members to use alcohol as self medication to get some sleep. They can now say "I found my medicine, I can take the prazosin, I don't have to use alcohol, I can get a decent night's sleep and I'm not tired during the day." because prazosin is not a sedating medication. When restorative sleep resumes, you feel better and you do better. This is not rocket science. But it is extremely important. Every year more and more veterans with a PTSD diagnosis are prescribed prazosin for their post-traumatic stress disorder, such that in 2008 more than 26,000 U.S. veterans were prescribed Prazosin for this indication. But this is an inexpensive generic drug, there is no pharmaceutical company's support for promotion so the study we're doing that is funded by the CDMRP and the resulting publications are extremely critical because it's the only way for us to get the word out. Fortunately, we have word of mouth so that even in the active duty military downrange, deployed in Iraq and Afghanistan, more and more mental health providers are aware of prazosin as well as general medical practitioners are aware of prazosin, are using it, and it's a force multiplier. This is perhaps the only carefully rated report of clinical experience with any drug to treat a behavioral, or if you will, psychiatric symptom in the active combat theater.