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Prazosin for treatment of post-traumatic stress disorder: a systematic review and meta-analysis

Published online by Cambridge University Press:  04 May 2020

Christopher Reist Open the ORCID record for Christopher Reist [Opens in a new window] ,
Elani Streja ,
Cynthia Crystal Tang ,
Bryan Shapiro ,
Jim Mintz  and
Michael Hollifield
Christopher Reist*
Affiliation:
Tibor Rubin Veteran Affairs Healthcare System, Long Beach, California, USA Department of Medicine, University of California, Irvine School of Medicine, Orange, California, USA Science 37, Playa Vista, California, USA
Elani Streja
Affiliation:
Tibor Rubin Veteran Affairs Healthcare System, Long Beach, California, USA Department of Medicine, University of California, Irvine School of Medicine, Orange, California, USA Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
Cynthia Crystal Tang
Affiliation:
Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
Bryan Shapiro
Affiliation:
Tibor Rubin Veteran Affairs Healthcare System, Long Beach, California, USA Department of Medicine, University of California, Irvine School of Medicine, Orange, California, USA
Jim Mintz
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
Michael Hollifield
Affiliation:
Tibor Rubin Veteran Affairs Healthcare System, Long Beach, California, USA
*
*Christopher Reist, MD, Email: creist@uci.edu
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Abstract

Background

Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD.

Methods

A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges’ g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies.

Results

Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD = −0.31; 95% confidence intervals [CI]: −0.62, −0.01), nightmares (SMD = −0.75; 95% CI: −1.24, −0.27), and sleep quality (SMD = −0.57; 95% CI: −1.02, −0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences.

Conclusions

Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.

Keywords

Post-traumatic stress disordernightmaressleepprazosinmeta-analysis
Type
Review
Information
CNS Spectrums , Volume 26 , Issue 4 , August 2021 , pp. 338 - 344
Copyright
© Cambridge University Press 2020

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